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Bachar G, Alter A, Justman N, Buchnik Fater G, Farago N, Ben-David C, Abu-Rass H, Siegler Y, Hajaj A, Landau-Levin M, Zipori Y, Khatib N, Weiner Z, Vitner D. Fixed-time interval vs on-demand oral analgesia after vaginal delivery: a randomized controlled trial. Am J Obstet Gynecol MFM 2024; 6:101372. [PMID: 38583715 DOI: 10.1016/j.ajogmf.2024.101372] [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: 02/17/2024] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Scheduled administration of analgesics was proven superior to on-demand dosing following cesarean deliveries. However, this protocol was not compared after vaginal delivery. OBJECTIVE To compare the efficacy of a fixed- vs on-demand analgesic protocol for the management of pain in the first 24 hours after a vaginal delivery. STUDY DESIGN This randomized, prospective, controlled trial was conducted at a single tertiary medical center between June 1, 2020 and June 30, 2022. Vaginally delivered patients were randomly assigned to receive oral analgesics (paracetamol 1 g + ibuprofen 400 mg) either every 6 hours for the first 24 hours postpartum (scheduled analgesia group) or as needed (on-demand group). Pain level during the first 24 hours postdelivery was measured using a 10-point visual analog scale. RESULTS A total of 200 patients were randomized 1:1 to the 2 cohorts. Baseline and delivery characteristics, including oxytocin augmentation, epidural anesthesia, episiotomy rate, and neonatal birthweight, were comparable between groups. Patients in the scheduled group received more paracetamol and ibuprofen doses in the first 24 hours (2.9±1.3 and 2.9±1.2 doses vs 0.8±1.1 and 0.7±1.1 doses, respectively; P<.001). Pain score was comparable between study groups (5.31±1.92 vs 5.29±1.67; P=.626) even after subanalysis for primiparity, episiotomy, and vacuum-assisted delivery (P>.05). However, patients on a fixed treatment schedule were more likely to breastfeed their baby (98% vs 88%; P=.006) as than those receiving treatment on demand. In addition, they were more satisfied with their labor and delivery experience, as evaluated by Birth Satisfaction Scale questionnaires quality control (37.9±4.7 vs 31.1±5.2; P=.0324), patient attributes (35.0±5.1 vs 30.3±6.3; P=.0453), and stress experienced (58.1±8.5 vs 50.1±8.3; P=.0398). No side effects or adverse outcomes were reported in either group. CONCLUSION A scheduled analgesic protocol for postpartum pain management following vaginal delivery revealed similar pain scores compared with an on-demand protocol, although it was associated with higher breastfeeding rates and higher maternal satisfaction.
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Affiliation(s)
- Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner).
| | - Adi Alter
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner)
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner)
| | - Gili Buchnik Fater
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner)
| | - Naama Farago
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner)
| | - Chen Ben-David
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner)
| | - Hiba Abu-Rass
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner)
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner)
| | - Areen Hajaj
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner)
| | - Maya Landau-Levin
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner)
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner); Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Zipori, Khatib, Weiner, and Vitner)
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner); Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Zipori, Khatib, Weiner, and Vitner)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner); Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Zipori, Khatib, Weiner, and Vitner)
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Bachar, Alter, Justman, Buchnik Fater, Farago, Ben-David, Abu-Rass, Siegler, Hajaj, Landau-Levin, Zipori, Khatib, Weiner, and Vitner); Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Zipori, Khatib, Weiner, and Vitner)
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Justman N, Goldfriend R, Rosh B, Wolfovitch A, Siegler Y, Tzur L, Bachar G, Buchnik G, Zipori Y, Khatib N, Weiner Z, Vitner D. Exploring the Optimal Intertwin Delivery Interval for Vaginal Delivery. Reprod Sci 2024:10.1007/s43032-024-01497-9. [PMID: 38424406 DOI: 10.1007/s43032-024-01497-9] [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: 06/15/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
The effect of prolonged intertwin delivery interval (IDI) is not well studied. This work aimed to assess the inflection point for Cesarean delivery (CD) and associated adverse maternal and neonatal outcomes. This was a retrospective cohort study at a single tertiary care center. The study included women with twin pregnancies in 2010-2019 who reached the second stage of labor, and assessed the most predictive cutoff for CD using Youden J statistic and compared adverse maternal and neonatal outcomes between short and prolonged intertwin delivery intervals. A total of 461 gravidas reached the second stage of labor and were included in the study. Using the ROC curve and Youden J statistic, the IDI cutoff was set at 15 min (80% sensitivity, 75% specificity, p < 0.001), with 312 women in the short and 149 in the prolonged IDI groups. Women in the prolonged IDI group were less likely to deliver the second twin vaginally (75.8% vs. 93.3%, p < 0.001). Postpartum hemorrhage (PPH) (39.1% vs. 24.7%, p = 0.01), and placental abruption (4% vs. 1%, p = 0.03) were more likely to occur in the prolonged IDI group. An increased rate of neonatal acidemia and low 5-min Apgar score were also found in the prolonged IDI group (15.7% vs. 4.3%, P = 0.01, 9.7% vs. 3.5%, p = 0.008; respectively). IDIs of more than 15 min are associated with increased risk of adverse maternal and neonatal outcomes. These findings should be used for counseling and managing twin pregnancies attempting vaginal delivery.
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Affiliation(s)
- Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.
| | - Roee Goldfriend
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Bar Rosh
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Wolfovitch
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Lilia Tzur
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Gili Buchnik
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Justman N, Somer S, Goldfreind R, Abu-Rass H, Siegler Y, Shahak G, Bachar G, Copel JA, Zipori Y, Khatib N, Weiner Z, Vitner D. The optimal cutoff for intertwin delivery interval: A retrospective cohort study. Int J Gynaecol Obstet 2024. [PMID: 38258901 DOI: 10.1002/ijgo.15382] [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: 11/09/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To determine the cutoff of intertwin delivery intervals (IDIs) as a predictor for neonatal acidemia. METHOD This retrospective cohort study was conducted at a single tertiary care center. Women attempting vaginal delivery of twins between 2010 and 2019 and who reached the second stage of labor were included. The cutoff point for prolonged IDI was established using a receiver operating characteristic (ROC) curve and Youden's J statistic. Maternal and neonatal outcomes were compared between short and prolonged IDI cohorts. RESULTS A total of 461 women were included in the study. A cutoff time of 10 min was found to be the best predictor for neonatal acidemia (arterial cord pH ≤ 7.1), with a sensitivity of 90% and a specificity of 59%. Second twins delivered more than 10 min after the first twin were more likely to be acidemic and to have a 5-min Apgar score of 7 or less (13.5% vs 3.3%, P = 0.01, and 8.4% vs 3.2%, P = 0.02, respectively). An IDI of more than 10 min was also associated with increased rate of cesarean delivery and placental abruption (13.5% vs 0.8%, P < 0.001, and 3.4% vs 0.8%, P = 0.047, respectively). No other adverse maternal or neonatal outcomes were statistically significant between cohorts. CONCLUSION An IDI of more than 10 min is associated with a higher risk for neonatal academia, with a low 5-min Apgar score, and higher cesarean delivery and placental abruption rates. These findings provide insights that are valuable when counseling and managing twin pregnancies attempting vaginal delivery. Interventions aimed at shortening the IDI should be considered to prevent adverse neonatal outcomes.
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Affiliation(s)
- Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Shmuel Somer
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Roee Goldfreind
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Hiba Abu-Rass
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Gilad Shahak
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | | | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Ben-David C, Bachar G, Shbita D, Justman N, Vitner D, Khatib N, Ginsberg Y, Beloosesky R, Weiner Z, Zipori Y. Pre-labour Rupture of Membranes at Term in Women With Gestational Diabetes and the Risk of Neonatal Hypoglycemia. Journal of Obstetrics and Gynaecology Canada 2024; 46:102234. [PMID: 37820928 DOI: 10.1016/j.jogc.2023.102234] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES The management for improving maternal and neonatal outcomes of women with gestational diabetes mellitus (GDM) arriving at the delivery ward with pre-labour rupture of membranes (PROM) has not been elucidated. We tested the hypothesis that prolonged PROM in women with GDM would result in higher rates of neonatal hypoglycemia. METHODS We retrospectively enrolled women with diet or insulin-controlled GDM who presented with spontaneous clear PROM. Each woman was allocated into one of two groups based on the PROM-delivery time: <18 hours (group 1) and ≥18 hours (group 2). The primary outcome was the incidence of neonatal hypoglycemia, defined as glucose <40 mg/dL (2.2 mmol/L) within 24 hours of birth. RESULTS We ultimately analyzed 631 cases of GDM (6.7%), 371 with PROM-delivery <18 hours, and 260 with PROM-delivery ≥18 hours. The incidence of neonatal hypoglycemia did not differ between the two groups, reaching 7.3%. Women in group 2 were at increased risk of both cesarean delivery (20% vs. 12.4%, P < 0.01) and maternal chorioamnionitis morbidity (6.5% vs. 1.3%, P < 0.001). CONCLUSIONS In a sub-group of women with GDM, a PROM-delivery time ≥18 hours is not associated with higher rates of neonatal hypoglycemia, but higher rates of chorioamnionitis and cesarean delivery were noted. Therefore, we suggest consideration for early delivery when managing women with GDM and PROM.
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Affiliation(s)
- Chen Ben-David
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.
| | - Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Dima Shbita
- Ruth and Bruce Rappaport Faculty of Medicine-Technion Institute of Technology, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine-Technion Institute of Technology, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine-Technion Institute of Technology, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine-Technion Institute of Technology, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine-Technion Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine-Technion Institute of Technology, Haifa, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine-Technion Institute of Technology, Haifa, Israel
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Bachar G, Abu-Rass H, Farago N, Justman N, Buchnik G, Chen YS, David CB, Goldfarb N, Khatib N, Ginsberg Y, Zipori Y, Weiner Z, Vitner D. Continuous vs intermittent induction of labor with oxytocin in nulliparous patients: a randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:101176. [PMID: 37813304 DOI: 10.1016/j.ajogmf.2023.101176] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/13/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Oxytocin is considered the drug of choice for the induction of labor, although the optimal protocol and infusion duration remain to be determined. OBJECTIVE This study aimed to assess whether the duration of oxytocin infusion increases 24-hour delivery rates and affects the length of time-to-delivery and patient's experience. STUDY DESIGN A randomized controlled trial was performed at a single tertiary medical center, between January 1, 2020 and June 30, 2022. Nulliparous patients with a singleton pregnancy at a vertex presentation and a Bishop score ≥6 were randomly assigned to receive either continuous (16 hours, with a 4 hours pause in between infusions) or intermittent (8 hours, with a 4 hours pause in between infusions) oxytocin infusion, until delivery. In both groups, infusion was halted when signs of maternal or fetal compromise were observed. Randomization was conducted with a computer randomization sequence generation program. The primary outcome was delivery within 24 hours from the first oxytocin infusion and the secondary outcome included time-to-delivery, mode of delivery, and additional maternal and neonatal outcomes. Seventy-two patients per group were randomized to reach 80% statistical power with a 20% difference in the primary outcome according to previous studies. RESULTS A total of 153 patients were randomized, 72 to the continuous oxytocin infusion group and 81 to the intermittent infusion group. The total oxytocin infusion time was similar between the groups. Patients in the continuous arm were more likely to deliver within 24 hours from oxytocin initiation (79.73% vs 62.96%, P<.05), and had a shorter oxytocin-to-delivery time interval, compared with patients receiving intermittent treatment (9.3±3.7 hours vs 21±11.7 hours, P<.001). Furthermore, time from ruptured membranes to delivery was shorter (9.3±3.7 hours vs 21±11.7 hours; P<.0001) and chorioamnionitis was less frequent (9.46% vs 21%; P<.05) in the continuous compared with the intermittent arm. Cesarean delivery rate was 20% in both groups (P=.226). There was no difference in postpartum hemorrhage, or adverse neonatal outcomes between the groups. Patients receiving continuous oxytocin infusion were more satisfied with the birthing experience. CONCLUSION Continuous infusion of oxytocin for labor induction in nulliparous patients with a favorable cervix may be superior to intermittent oxytocin infusion, because it shortens time-to-delivery, decreases chorioamnionitis rate, and improves maternal satisfaction, without affecting adverse maternal or neonatal outcomes.
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Affiliation(s)
- Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana).
| | - Hiba Abu-Rass
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Naama Farago
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Gili Buchnik
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Yoav Siegler Chen
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Chen Ben David
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Nirit Goldfarb
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana); Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana); Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana); Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana); Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gal, Hiba, Naama, Naphtali, Gili, Yoav, Chen, Mr Nirit, Drs Nizar, Yuval, Yaniv, Zeev, and Dana); Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Nizar, Yuval, Yaniv, Zeev, and Dana)
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Lauterbach R, Justman N, Ginsberg Y, Siegler Y, Bachar G, Vitner D, Ben-David C, Zipori Y, Beloosesky R, Weiner Z, Khatib N. The impact of extending the second stage of labor on repeat cesarean section and maternal and neonatal outcome. Int J Gynaecol Obstet 2023; 163:594-600. [PMID: 37177788 DOI: 10.1002/ijgo.14855] [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: 09/12/2022] [Revised: 04/23/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To evaluate the effects of extending the second stage of labor in women attempting a trial of labor after a cesarean section (TOLAC). METHOD A retrospective cohort study comparing maternal and neonatal outcomes following TOLAC over two periods: period I whose prolonged second stage was considered 2 h, and period II whose prolonged second stage was considered 3 h. The primary outcome was repeat cesarean delivery (CD) rate. RESULTS Incidence of repeat CD was significantly lower in period II (18.1% vs 29.7%, P < 0.001). Incidence of uterine rupture was significantly higher in period II (P < 0.001). Instrumental delivery rates were significantly higher in period II (26.2% vs 15.6%, odds ratio [OR] 1.67, 95% CI 1.21-3.56, P < 0.001). Rates of third- and fourth-degree perineal lacerations, chorioamnionitis, and length of hospital stay were similar between groups. Incidence of fetal acidemia was significantly higher in period II (1.5% vs 0.7%, OR 2.14, 95% CI 1.32-5.63, P < 0.001), and incidence of neonatal intensive care unit (NICU) admission was significantly higher (2.5% vs 1.6%, P = 0.004). CONCLUSION Extension of the second stage of labor is associated with a decrease in repeat CD rate with a concomitant increase in instrumental delivery rates, uterine rupture, fetal acidemia, and NICU admissions. These findings may warrant further consideration of allowing a prolonged second stage in patients attempting TOLAC.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Chen Ben-David
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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7
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Bachar G, Siegler Y, Kabakov E, Lauterbach R, Justman N, Ben-Ezry E, Weiner E, Ganor-Paz Y, Yefet E, Khamaisi T, Nachum Z, Massalha M, Shamali K, Khatib N, Zipori Y, Weiner Z, Vitner D. Intermittent vs continuous catheterization for postpartum urinary retention: A multicenter randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:101084. [PMID: 37423430 DOI: 10.1016/j.ajogmf.2023.101084] [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: 05/01/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Postpartum urinary retention is a common complication in the immediate postpartum period. However, there is no consensus regarding optimal management. OBJECTIVE This study aimed to compare 2 catheterization strategies for the treatment of postpartum urinary retention. STUDY DESIGN A multicenter prospective randomized controlled trial was conducted at 4 university-affiliated medical centers between January 2020 and June 2022. Individuals with postpartum urinary retention (bladder volume of >150 mL) up to 6 hours after vaginal or cesarean delivery were randomly allocated to 1 of 2 protocols: intermittent catheterization every 6 hours, up to 4 times, or continuous catheterization with an indwelling urinary catheter for 24 hours. If postpartum urinary retention was not resolved after 24 hours, an indwelling catheter was inserted for an additional 24 hours in both groups. The primary endpoint was the mean time to postpartum urinary retention resolution. The secondary endpoints included postcatheter urinary tract infection rate and length of hospital stay. The satisfaction rate was estimated using the 30-Item Birth Satisfaction Scale questionnaire. RESULTS After randomization, 73 individuals were allocated to the intermittent catheterization group, and 74 individuals were allocated to the continuous catheterization group. The mean time to postpartum urinary retention resolution was significantly shorter in the intermittent catheterization group than in the continuous catheterization group (10.2±11.8 vs 26.5±9.0 hours; P<.001), with 75% and 93% resolution rates after 1 and 2 catheterizations, respectively. The number of individuals who achieved resolution at 24 hours was 72 (99%) in the intermittent catheterization group and 67 (91%) in the continuous catheterization group (P=.043). The satisfaction rate was higher in all categories in the intermittent catheterization group than in the continuous catheterization group (P<.001). No intercohort difference was found in the urinary tract infection rates (P=.89) or hospital stay length (P=.58). CONCLUSION Compared with indwelling catheterization, intermittent catheterization for urinary retention after delivery was associated with quicker postpartum urinary retention resolution and a higher satisfaction rate without increasing the complication rates.
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Affiliation(s)
- Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner).
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Eli Kabakov
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Emilie Ben-Ezry
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel (Dr Ben-Ezry, Dr Weiner, and Dr Ganor-Paz)
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel (Dr Ben-Ezry, Dr Weiner, and Dr Ganor-Paz)
| | - Yael Ganor-Paz
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel (Dr Ben-Ezry, Dr Weiner, and Dr Ganor-Paz)
| | - Enav Yefet
- Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel (Dr Yefet); Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (Dr Yefet and Dr Khamaisi)
| | - Thana Khamaisi
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (Dr Yefet and Dr Khamaisi)
| | - Zohar Nachum
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Dr Nachum, Dr Massalha, and Dr Weiner); Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Dr Nachum, Dr Massalha, and Dr Shamali)
| | - Manal Massalha
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Dr Nachum, Dr Massalha, and Dr Weiner); Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Dr Nachum, Dr Massalha, and Dr Shamali)
| | - Khadeje Shamali
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Dr Nachum, Dr Massalha, and Dr Shamali)
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner); Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Dr Nachum, Dr Massalha, and Dr Weiner)
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
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8
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Justman N, Goldfreind R, Abu-Rass H, Siegler Y, Shahak G, Wolfovitz A, Ginsberg Y, Zipori Y, Khatib N, Weiner Z, Vitner D. Risk Factors for Prolonged Intertwin Delivery Interval and Associated Maternal and Second Twin Morbidity. Am J Perinatol 2023. [PMID: 37557897 DOI: 10.1055/s-0043-1772229] [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: 08/11/2023]
Abstract
OBJECTIVE This work aimed to identify possible risk factors and the morbidity associated with prolonged intertwin delivery interval (IDI). STUDY DESIGN A retrospective cohort study at a single tertiary care center. Women with twin gestations who reached the second stage of labor between January 2010 and December 2019 were included in the study. Demographic and clinical characteristics were compared between short IDI (≤15 minutes) and prolonged IDI (>15 minutes). The primary outcome was the rate of 5-minute Apgar score ≤ 7. RESULTS A total of 461 women were included; 312 of whom were in the short IDI group and 149 were in the prolonged IDI group. Rates of 5-minute Apgar score ≤ 7 and neonatal acidemia were significantly higher in the prolonged IDI group (3.5 vs. 9.7%, p = 0.008; 4.3 vs. 15.7%, p = 0.01, respectively). Vaginal delivery was less likely to occur in the prolonged IDI group (75.8 vs. 93.3%). Placental abruption and hemoglobin drop ≥ 3 g/dL were more prevalent in the prolonged IDI group (4 vs. 1%, p = 0.03; 39.1 vs. 24.7%, p = 0.01, respectively). In the multivariate analysis, age ≥ 30 years (adjusted odds ratio [aOR]: 1.76, p = 0.01), nulliparity (aOR: 1.66, p = 0.03), and birth weight ratio ≥ 1.2 (aOR: 1.92, p < 0.05) were associated with prolonged IDI. CONCLUSION Prolonged IDI is associated with an increased risk for neonatal acidemia and low 5-minute Apgar score, and with an increased rate of cesarean delivery, placental abruption, and hemoglobin drop ≥ 3 g/dL. Advanced maternal age, nulliparity, and twin birth weight ratio ≥ 1.2 are associated with prolonged IDI. KEY POINTS · Prolonged was found to be associated with higher neonatal acidemia and lower 5-minute Apgar score.. · Prolonged IDI is also associated with increased rate of cesarean delivery, placental abruption, and blood loss.. · Advanced maternal age, birth weight discordancy, and nulliparity were associated with prolonged IDI..
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Affiliation(s)
- Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Roee Goldfreind
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Hiba Abu-Rass
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Gilad Shahak
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Amir Wolfovitz
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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9
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Lauterbach R, Bachar G, Justman N, Siegler Y, Khatib N, Weiner Z, Vitner D. Is 25 mm the correct mid-trimester cut-off for cervical shortening among asymptomatic women? Int J Gynaecol Obstet 2023; 161:218-224. [PMID: 35962710 DOI: 10.1002/ijgo.14396] [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: 01/28/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To evaluate the impact of asymptomatic cervical shortening (ACS) at mid-trimester on maternal and neonatal outcomes. METHODS This was a retrospective cohort study. Women with singleton gestations and an accidental finding of cervical length of 25 mm or less at mid-trimester were compared with women with symptomatic cervical shortening (SCS) and women with normal cervical length (NCL). Primary outcome was preterm birth (PTB) rate; secondary outcomes included total hospitalization length, betamethasone treatment rate, and a composite of PTB neonatal outcomes. RESULTS In all, 1483 women were diagnosed with ACS. There was no difference in early and late PTB rate between the ACS and NCL groups (4.9% versus 3.8%, P = 0.25), though there was a significantly higher rate of antenatal corticosteroids use in the ACS group (78.2% versus 7.4%, P < 0.001). A CL of 15 mm or less was significantly associated with both early and late PTB, compared with the NCL group (47.2% versus 3.6%, P < 0.001, and 35.8% versus 3.8%, P < 0.001). CONCLUSIONS An ACS of 15-25 mm is not associated with an increased risk of PTB. In contrast, women with a CL of 15 mm or less are more likely to delivery prematurely compared with women with a CL greater than 15 mm.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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10
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Gutzeit O, Justman N, Zvi DB, Siegler Y, Khatib N, Ginsberg Y, Beloosesky R, Weiner Z, Vitner D, Liberman S, Zipori Y. Late preterm delivery has a distinctive second-stage duration and characteristics. Am J Obstet Gynecol MFM 2023; 5:100845. [PMID: 36572106 DOI: 10.1016/j.ajogmf.2022.100845] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Late preterm neonates born between 34.0 and 36.6 weeks' gestation are at increased risk for short- and long-term morbidity and mortality when compared with their term counterparts. Currently, no separate labor curve is available for late preterm births, and this group's optimal duration of the second stage of labor has never been defined separately. OBJECTIVE This study aimed to compare the second stage duration between late preterm and term births. STUDY DESIGN This was a retrospective study from May 2014 until May 2021. Eligible were women with a singleton pregnancy, vertex presentation, spontaneous or induced onset of labor, and those who delivered vaginally beyond 34.0 weeks of gestation. The primary outcome of our study was to compare and characterize the second stage of labor duration between late preterm and term births. RESULTS We analyzed 962 late preterm and 9476 term vaginal deliveries. Women who delivered during the late preterm period were more likely to be multiparous (52.4% vs 45.2%; P<.001) and fewer required oxytocin during labor (41.2% vs 54.4%; P<.001) or used epidural analgesia (75.2% vs 83.6%; P<.001). The overall mean duration of the second stage of labor was significantly shorter in the late preterm period than at term (1.08±1.09 hours vs 1.49±1.22 hours; P<.001). This was even more pronounced for nulliparous women (1.05±1.00 hours vs 2.10±1.17 hours; P<.001). Among multiparous women, epidural use significantly affected the duration of the second stage of labor, and the second stage was relatively longer during the late preterm period than at term in this subgroup (1.16 vs 0.5 hours; P<.001). Using a multivariate Cox regression, variables such as maternal age (hazard ratio, 1.02; 95% confidence interval, 1.01-1.04), parity (hazard ratio, 4.11; 95% confidence interval, 3.65-4.63), preterm birth (hazard ratio, 2.08; 95% confidence interval, 1.4-3.10), and birthweight at delivery (hazard ratio, 1.15; 95% confidence interval, 1.01-1.30) shortened the second stage, whereas induction of labor (hazard ratio, 0.75; 95% confidence interval, 0.66-0.86) and epidural use (hazard ratio, 0.68; 95% confidence interval, 0.64-0.86) extended its total duration. Regardless of parity, lower rates of operative vaginal deliveries were observed in the late preterm period than at term (3.7% vs 15.5%; P<.001). This period was also associated with lower rates of third- and fourth-degree perineal lacerations (0.2% vs 2.2%; P<.001) but higher rates of chorioamnionitis (1.7% vs 0.1%; P<.001), Apgar score at 5 minutes <7 (1.0% vs 0.2%; P<.001), and admission to the neonatal intensive care unit (19.3% vs 1.0%; P<.001). CONCLUSION Women who delivered vaginally during the late preterm period had a distinctive second-stage duration. Primarily, it was shown to be significantly shorter for nulliparous and multiparous women. Future studies should further clarify the optimal duration of this stage in relation to neonatal outcomes at such a vulnerable period.
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Affiliation(s)
- Ola Gutzeit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori)
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori)
| | - Dikla Ben Zvi
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori)
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori)
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori)
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori)
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori)
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori)
| | - Sapir Liberman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori)
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Gutzeit, Justman, Ben Zvi, Siegler, Khatib, Ginsberg, Beloosesky, Weiner, Vitner, Liberman, and Zipori); Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Khatib, Ginsberg, Beloosesky, Weiner, Vitner, and Zipori).
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11
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Lauterbach R, Ben David C, Bachar G, Justman N, Matanes E, Ginsberg Y, Vitner D, Beloosesky R, Weiner Z, Zipori Y. Continuous versus disrupted subcutaneous tissue closure in cesarean section: A retrospective cohort study. Int J Gynaecol Obstet 2023; 160:113-119. [PMID: 35766992 DOI: 10.1002/ijgo.14322] [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: 12/19/2021] [Revised: 03/01/2022] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare rates of surgical-site infections following continuous, as compared with interrupted, subcutaneous tissue closure technique during cesarean delivery (CD). METHODS A retrospective cohort study during 2008-2018. The study group included women who underwent either elective or emergent CD with continuous subcutaneous tissue closure, while the control group comprised those with interrupted subcutaneous tissue closure. We excluded women with suspected infectious morbidity before CD. The primary outcome was surgical-site infection (SSI) rate. RESULTS The final analysis included 6281 women. We performed continuous subcutaneous tissue closure in 37.4% (1867/4988) of scheduled CD, and 45.8% (592/1293) of emergent CD. The rate of SSI was significantly lower following continuous than interrupted subcutaneous tissue closure, in both elective CD (2.7% versus 4.5%, respectively, P = 0.031) and emergent CD (3.2% versus 5.4%, respectively, P = 0.036) in nulliparous and multiparous women. Similarly, secondary outcomes such as re-admission rates, postoperative maternal fever, and need for antibiotic treatment were significantly lower following continuous subcutaneous closure. CONCLUSIONS Continuous subcutaneous closure technique during CD yields a lower rate of surgical-site complications compared with the interrupted technique.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Chen Ben David
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth & Bruce Rappaport Faculty of Medicine-Technion Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth & Bruce Rappaport Faculty of Medicine-Technion Institute of Technology, Haifa, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
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Lauterbach R, Justman N, Siegler Y, Bachar G, Ginsberg Y, Vitner D, Zipori Y, Beloosesky R, Weiner Z, Khatib N. Prolongation of the second stage of labor affects TOLAC success. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.406] [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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13
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Bachar G, Abu-Rass H, Lauterbach R, Farago N, Justman N, Khatib N, Zipori Y, Weiner Z, Vitner D. Continuous versus Intermittent Oxytocin Induction in Nulliparous: A Randomized Controlled Trial. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.262] [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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Justman N, Goldfreind R, Abu-Rass H, Siegler Y, Bachar G, Shahak G, Lauterbach R, Zipori Y, Khatib N, Weiner Z, Vitner D. The Optimal Cutoff Time for Defining Prolonged Intertwin Delivery Interval. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.383] [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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Lauterbach R, Aharoni S, Justman N, Farago N, Gruenwald I, Lowenstein L. The efficacy and safety of a single maintenance laser treatment for stress urinary incontinence: a double-blinded randomized controlled trial. Int Urogynecol J 2022; 33:3499-3504. [PMID: 35195738 PMCID: PMC8864590 DOI: 10.1007/s00192-022-05103-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the efficacy and safety of a single carbon dioxide (CO2) laser maintenance treatment in women previously treated successfully with laser for stress urinary incontinence (SUI), who have demonstrated a decline in treatment effect. METHODS Women aged 40-70 years who experienced temporary significant improvement in symptoms following CO2 laser treatments for SUI were randomized to either the treatment group or the sham treatment control group. Cough test results, 1-h pad weights and scores on the Urogenital Distress Inventory (UDI6), the International Consultation of Incontinence Questionnaire (ICIQ-UI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were obtained at baseline and 3 and 6 months. RESULTS Of 183 women screened, 131 were included in the final analysis. Demographic characteristics and baseline measures in the outcome tests were similar between the groups. Statistically significant improvements were demonstrated in the study compared to the control group at 3 months post-treatment in positive cough test (44.4% vs. 79.4%, P = 0.002), mean pad weight test (2.3 g ± 1.3 vs. 5.6 ± 1.1, P < 0.001), mean UDI-6(24.7 ± 12.1 vs. 45.1 ± 13.6 SD, P = 0.004), mean ICIQ-UI (16.5 ± 4.3 vs. 10.3 + 3.8, P = 0.003) and mean PISQ-12 (21.3 ± 6.8 vs. 36.6 ± 7.5, P = 0.003). However, values at 6 months post-treatment were similar to those at baseline. CONCLUSIONS Our results suggest that a single maintenance laser treatment for reducing symptoms of SUI is transiently effective, well tolerated and safe. This treatment modality provides alternative non-surgical therapy for women with SUI.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601, Haifa, Israel.
| | - Saar Aharoni
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601, Haifa, Israel
| | - Naama Farago
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601, Haifa, Israel
| | - Ilan Gruenwald
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Lauterbach R, Gruenwald O, Matanes E, Justman N, Mor O, Vitner D, Avrahami R, Ghanem N, Zipori Y, Weiner Z, Lowenstein L. A randomized controlled trial of 2 techniques of salpingectomy during cesarean delivery. Am J Obstet Gynecol MFM 2022; 4:100690. [PMID: 35843545 DOI: 10.1016/j.ajogmf.2022.100690] [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: 03/26/2022] [Revised: 06/17/2022] [Accepted: 07/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Total salpingectomy during benign gynecologic surgery is recommended after completion of childbearing to reduce the risk of developing ovarian cancer. OBJECTIVE This study aimed to assess operating time and complication rates of "traditional" salpingectomy using the "Knot and Cut" technique, compared with bipolar salpingectomy for sterilization at the time of cesarean delivery. STUDY DESIGN This was a randomized controlled trial. Women undergoing planned cesarean delivery who desired sterilization were randomized to traditional salpingectomy or bipolar salpingectomy. The bipolar salpingectomy was performed using the LigaSure Precise. The primary outcome was the surgical time of the salpingectomy procedure. Secondary outcomes included total cesarean delivery time and associated bleeding parameters. We estimated that 42 patients would provide 80% power and a 2-sided alpha of 0.05 to identify a 10-minute difference in the primary outcome. RESULTS A total of 26 women were randomized to bipolar salpingectomy and 25 to traditional salpingectomy. Baseline demographic characteristics were similar between the groups. Six procedures were converted from traditional to bipolar salpingectomy, and 2 traditional salpingectomies failed. The surgical time (16.16±9.53 vs 5.19±3.57 minutes; P<.001), estimated blood loss (928.08±414.66 mL vs 677.15±380.42 mL; P=.029), and need for blood transfusion (20% vs 0%; P=.016) were significantly greater in the traditional salpingectomy than in the bipolar salpingectomy group. The cesarean delivery time was similar (88.92±17.87 vs 88.23±19.85 minutes; P=.89). Hospitalization time was significantly longer following traditional salpingectomy than bipolar salpingectomy (5.24±2.27 vs 3.92±2.01 days; P=.034). CONCLUSION "Traditional" salpingectomy is associated with longer surgical and hospitalization time, and greater blood loss and risk of blood transfusion compared with "bipolar" salpingectomy. In practices in which "bipolar" salpingectomy is available, it should be preferred over alternative methods of salpingectomy.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein).
| | - Oren Gruenwald
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
| | - Omer Mor
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein); The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Vitner, Weiner, and Lowenstein)
| | - Roni Avrahami
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
| | - Nadir Ghanem
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein); The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Vitner, Weiner, and Lowenstein)
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein); The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Vitner, Weiner, and Lowenstein)
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Lauterbach R, Bachar G, Ben-David C, Justman N, Siegler Y, Tzur L, Copel JA, Weiner Z, Beloosesky R, Ginsberg Y. Postpartum cervical length as a predictor of subsequent preterm birth - a novel insight that sheds some light on an old enigma. Am J Obstet Gynecol 2022; 228:461.e1-461.e8. [PMID: 36265677 DOI: 10.1016/j.ajog.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preterm birth poses one of the biggest challenge in modern obstetrics. Prediction of preterm birth has previously been based on patient history of preterm birth, short cervical length around midtrimester, and additional maternal risk factors. Little is known about cervical length and physiology during the postpartum period and any associations between postpartum cervical features and subsequent preterm birth. OBJECTIVE This study aimed to determine the feasibility and utility of postpartum cervical length measurements in prediction of subsequent spontaneous preterm birth. STUDY DESIGN This was a prospective cohort study in a single tertiary center, conducted during a 5-year period (2017-2021). We evaluated the mean postpartum cervical length in patients after both preterm birth and term deliveries at 4 time periods: 8, 24, and 48 hours, and 6 weeks postpartum, with follow-up in their subsequent pregnancies to evaluate gestational age at delivery. The mean postpartum cervical length in different populations stratified by gestational age at delivery was assessed in phase 1 of the study, and the gestational age at subsequent delivery was assessed in phase 2. RESULTS A total of 1384 patients participated in phase 1. Mean postpartum cervical length was significantly shorter in the preterm birth (<34 weeks' gestation) group than in the term group at 8 hours (8.4±4.2 vs 22.3±3.5 mm; P<.0001), 24 hours (13.2±3.8 vs 33.2±3.1 mm; P<.0001), and 48 hours (17.9±4.4 vs 40.2±4.2 mm; P<.0001) postpartum. There was no significant difference in mean postpartum cervical length between the preterm birth group and the term group at 8, 24, and 48 hours postpartum. Cervical length was similar between the groups at 6 weeks postpartum. A total of 891 patients participated in phase 2. The area under the curve was higher for preterm birth screening based on a history of a short postpartum cervix alone than for a history of spontaneous preterm birth alone (0.66 [95% confidence interval, 0.63-0.69] vs 0.57 [95% confidence interval, 0.54-0.61]; P<.0001). Combining both a history of spontaneous preterm birth and a short postpartum cervix resulted in additional benefit, with an area under the curve of 0.74 (95% confidence interval, 0.73-0.84; P<.0001). CONCLUSION Postpartum cervical length measurements may assist in detecting the group of patients at higher risk of subsequent spontaneous preterm birth. It may be beneficial to consider an increased follow-up regimen and earlier interventions in this group to reduce adverse perinatal outcomes.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.
| | - Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Chen Ben-David
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Lilia Tzur
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | | | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Zipori Y, Lauterbach R, Justman N, Hajaj A, David CB, Ginsberg Y, Khatib N, Weiner Z, Beloosesky R. Vaginal fluid index - The fifth amniotic pocket. Int J Gynaecol Obstet 2022; 159:923-927. [PMID: 35574997 DOI: 10.1002/ijgo.14265] [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: 11/13/2021] [Revised: 02/28/2022] [Accepted: 05/09/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The forebag is a pocket of amniotic fluid preceding the fetal presenting part. Herein we describe the feasibility of transvaginal measurements of the forebag and assess its correlation with the standard amniotic fluid index (AFI). METHODS A prospective study was carried out between January 2019 and July 2020. Eligible cases were women with singletons, vertex presentation, and normal AFI at term. We assessed the implementation and acceptance of a novel process in the clinical practice setting. Feasibility was assessed by using transvaginal ultrasound to measure the three orthogonal planes of the forebag. The vaginal fluid index (VFI) was defined as the volume composite of the three orthogonal planes. Correlations of the forebag measurements with both AFI and maximal vertical pocket were then calculated. RESULTS In total, 292 out of 305 (95.7%) women were enrolled. All participants completed both transabdominal and transvaginal ultrasound, of which the vaginal pocket was demonstrated in 266 (91.1%) cases. We found significant correlations, in both nulliparas and multiparas, between the vaginal pocket measurements and the VFI to both the AFI and maximal vertical pocket measurements (R = 0.38, P < 0.001; R = 0.3, P < 0.001, respectively). CONCLUSION We introduced a new ultrasound variable, the VFI, with a high feasibility rate. This may provide invaluable information for future decision making around the time of delivery.
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Affiliation(s)
- Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Areen Hajaj
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Chen Ben David
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth & Bruce Rappaport Faculty of Medicine - Technion Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth & Bruce Rappaport Faculty of Medicine - Technion Institute of Technology, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth & Bruce Rappaport Faculty of Medicine - Technion Institute of Technology, Haifa, Israel
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Lauterbach R, Ben Zvi D, Dabaja H, Zidan R, Justman N, Vitner D, Beloosesky R, Ghanem N, Ginsberg Y, Zipori Y, Weiner Z, Khatib N. Vaginal Dinoprostone Insert versus Cervical Ripening Balloon for Term Induction of Labor in Obese Nulliparas-A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11082138. [PMID: 35456231 PMCID: PMC9029246 DOI: 10.3390/jcm11082138] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
Data regarding the preferred induction method in women with obesity is scarce. The current study was aimed at comparing pharmacological and mechanical induction in this population. This prospective randomized controlled trial was conducted between 2016−2020, in nulliparas with a pre-pregnancy body mass index >30. Inclusion criteria were singleton-term pregnancies, bishop score < 5, and indication for induction. Patients were randomized to induction by a cervical ripening balloon (CRB) or a 10 mg vaginal dinoprostone insert. The primary outcome was delivery rate within 24 h. Secondary outcomes included time to delivery, cesarean section rate, maternal and neonatal outcomes, satisfaction, and anxiety. The study population comprised of 83 women in the CRB group and 81 in the dinoprostone group. There was a significant difference in delivery rates within 24 h and time to delivery between the dinoprostone and CRB groups (45% vs. 71%, p = 0.017 and 49.3 ± 6.8 h vs. 23.5 ± 5.9 h, p = 0.003, respectively). There were no differences in cesarean delivery rates or maternal and neonatal outcomes, though CRB induction was associated with a significantly lower rate of tachysystole. Induction with CRB was accompanied by higher satisfaction and lower anxiety. In summary, CRB induction is associated with shorter time to delivery, higher satisfaction, and lower anxiety compared to PGE2 in women with obesity, without compromising maternal or neonatal outcomes.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Correspondence: ; Tel.: +972-4-7771779; Fax: +972-4-7771778
| | - Dikla Ben Zvi
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Haneen Dabaja
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Ragda Zidan
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Nadir Ghanem
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
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Lauterbach R, Gruenwald I, Ersheed A, Mattar K, Matanes E, Justman N, Amnon A, Lowenstein L. Tension Free Vaginal Tape for Repair of Stress Urinary Incontinence Affects Vaginal Elasticity and Sexual Function. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0149] [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: 11/13/2022] Open
Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilan Gruenwald
- Department of Neuro-Urology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Angie Ersheed
- Department of Obstetrics and Gynecology, Ha`emek Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Kamel Mattar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amit Amnon
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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21
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Siegler Y, Justman N, Bachar G, Lauterbach R, Zipori Y, Khatib N, Weiner Z, Vitner D. Is there a benefit of antenatal corticosteroid when given < 48 h before delivery? Arch Gynecol Obstet 2022; 306:1463-1468. [PMID: 35099594 DOI: 10.1007/s00404-022-06411-9] [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: 09/19/2021] [Accepted: 01/15/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We assessed the association between a short antenatal corticosteroid administration-to-birth interval and neonatal outcome. STUDY DESIGN A retrospective study was conducted between 2010 and 2020. Eligible cases were singleton preterm live-born neonates born between 24-0/7 and 33-6/7 weeks of gestation and were initiated an ACS course of betamethasone. We divided the first 48 h following the first ACS administration to four time intervals and compared each time interval to those born more than 48 h following ACS administration. The primary outcome was a composite of adverse neonatal outcome, including neonatal mortality or any major neonatal morbidity. RESULTS A total of 200 women gave birth less than 48 h from receiving the first betamethasone injection, and 172 women gave birth within 2-7 days (48-168 h) from ACS administration. Composite adverse neonatal outcome was higher for neonates born less than 12 h from initial ACS administration compared to neonates born 2-7 days from the first betamethasone injection (55.45% vs. 29.07%, OR 3.45 95% CI [2.02-5.89], p value < 0.0001). However, there was no difference in composite adverse neonatal outcomes between neonates born 12-48 h following ACS administration and those born after 2-7 days. That was also true after adjusting for confounders. CONCLUSIONS 12-24 h following ACS administration may be sufficient in reducing the same risk of neonatal morbidities as > 48 h following ACS administration. It may raise the question regarding the utility of the second dose of ACS.
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Affiliation(s)
- Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Medical Center, Aalya St., Haifa, Israel.
| | - N Justman
- Department of Obstetrics and Gynecology, Rambam Medical Center, Aalya St., Haifa, Israel
| | - G Bachar
- Department of Obstetrics and Gynecology, Rambam Medical Center, Aalya St., Haifa, Israel
| | - R Lauterbach
- Department of Obstetrics and Gynecology, Rambam Medical Center, Aalya St., Haifa, Israel
| | - Y Zipori
- Department of Obstetrics and Gynecology, Rambam Medical Center, Aalya St., Haifa, Israel
| | - N Khatib
- Department of Obstetrics and Gynecology, Rambam Medical Center, Aalya St., Haifa, Israel
| | - Z Weiner
- Department of Obstetrics and Gynecology, Rambam Medical Center, Aalya St., Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - D Vitner
- Department of Obstetrics and Gynecology, Rambam Medical Center, Aalya St., Haifa, Israel
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Lauterbach R, Justman N, Siegler Y, Bachar G, Ben David C, Vitner D, Zipori Y, Beloosesky R, Weiner Z, Ginsberg Y. Presence of human papillomavirus increases risk of preterm birth even with normal cytology and biopsy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.379] [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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23
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Gutzeit O, Justman N, Ben Zvi D, Khatib N, Ginsberg Y, Beloosesky R, Weiner Z, Zipori Y. Late preterm second-stage of labor in relation to perinatal outcome. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.234] [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: 11/30/2022]
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Siegler Y, Justman N, Bachar G, Lauterbach R, Zipori Y, Khatib N, Weiner Z, Vitner D. Is there a benefit of Antenatal Corticosteroid when given < 48 hours before delivery? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1018] [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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25
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Lauterbach R, Ben David C, Siegler Y, Justman N, Bachar G, Vitner D, GHANIM N, Beloosesky R, Weiner Z, Ginsberg Y, Khatib N. Dinoprostone versus cervical ripening balloon for term nulliparous labor induction following primary Dinoprostone induction failure. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1036] [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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26
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Zidan R, Saad N, Sigler Y, Justman N, Mick I, Ben-Asher H, Beloosesky R, Ginsberg Y, Weiner Z, Zipori Y. The impact of prolonged second stage in twins on perinatal outcomes. Int J Gynaecol Obstet 2021; 157:347-352. [PMID: 34118077 DOI: 10.1002/ijgo.13787] [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: 03/12/2021] [Revised: 05/28/2021] [Accepted: 06/11/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the duration of the second stage of labor in twin pregnancies in relation to maternal and neonatal outcomes. METHODS A retrospective study between 2014 and 2020. Eligible cases were twin pregnancies that reached the second stage. The pre-defined groups were based on the total time spent in the second stage of labor; Group 1 (<1 h), group 2 (1-2 h), and group 3 (>2 h), which was considered the prolonged second stage group. RESULTS Among the 439 planned vaginal births, successful vaginal delivery of both twins was achieved in 63.8%. Prolonged second stage was observed in 25.8% (89/345). Nulliparity (odds ratio [OR] 7.72, 95% confidence interval [CI] 4.5-13.4) and use of epidural analgesia (OR 5.45, 95% CI 1.2-24.7), were the only independent variables significantly associated with prolonged second stage. Prolonged second stage was associated with a greater risk of intrapartum cesarean delivery (32.6%, P < 0.001), combined delivery (10.1%, P < 0.001), chorioamnionitis (8.3%, P = 0.006) and a admission to neonatal intensive care unit of at least one of the twins (30.3%, P = 0.02). CONCLUSION Prolonged second stage of labor affects maternal and fetal outcome in twin pregnancies.
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Affiliation(s)
- Ragda Zidan
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Niveen Saad
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Yoav Sigler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Ido Mick
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Hila Ben-Asher
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
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Justman N, Farahvar S, Ben-Shimol S. The implications of Rose Bengal test seroconversion in the diagnosis of brucellosis in children in an endemic region. Infect Dis (Lond) 2021; 53:340-347. [PMID: 33591841 DOI: 10.1080/23744235.2021.1885732] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The Rose Bengal test (RBT) is a commonly used simple serological test for brucellosis. We assessed brucellosis in individuals <18 years for RBT performance; duration of RBT positivity following infection; and potential factors associated with RBT seroconversion timing. METHODS The medical files of first hospital admissions of brucellosis, 2005-2014, southern Israel, were retrospectively reviewed. RESULTS Overall, RBT was positive in 99% of 416 primary brucellosis admissions. The mean age was 9.8 ± 4.5 years; all patients were of Bedouin ethnicity. Of 273 patients with subsequent RBT testing, RBT remained positive in 169 cases (duration range: 0.1-122 months). Overall, 104 patients had subsequent negative RBT result (duration range: 0.9-127; median: 29.9 months). Comparing fast (<30 months) vs. slow (≥30 months) seroconversion, IgM titres ≥1:640 were more common in fast seroconversion episodes (53% vs. 23%, p = .003). Anaemia was more common in the slow seroconversion group (76% vs. 52%, p = .02). Age, gender, ethnicity, fever, arthralgia, thrombocytopenia, leukopenia, liver enzymes, bacteraemia and adequate treatment rates were similar. CONCLUSIONS RBT positivity rate in first hospital visit was high. Fast negative seroconversion was associated with high IgM titres and lower anaemia rates at first presentation. These findings may assist early recognition of long-lasting brucellosis patients in endemic regions.
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Affiliation(s)
- Naphtali Justman
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Salar Farahvar
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ben-Shimol S, Farahvar S, Fruchtman Y, Justman N. Factors Associated With Single and Recurrent Bacteremia in Childhood Brucellosis. J Pediatric Infect Dis Soc 2020; 9:664-670. [PMID: 31840752 DOI: 10.1093/jpids/piz092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/05/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Data regarding risk factors of bacteremic brucellosis, and specifically recurrent bacteremia, are scarce. We assessed patients with childhood brucellosis, differentiating between those having culture-negative, single-bacteremic, and recurrent-bacteremic episodes. METHODS The medical files of pediatric brucellosis patients, from 2005 through 2014, were reviewed retrospectively. Univariate and multivariate analyses were performed to compare demographic and clinical characteristics of culture-negative, single-bacteremic, and recurrent-bacteremic (≥30 days between positive cultures) episodes. RESULTS Of all 436 brucellosis cases, 22% were culture-negative, 72% were single-bacteremic, and 6% were recurrent-bacteremic. In a univariate analysis, single-bacteremic episodes were associated with fever (90% vs 65% and 40% in culture-negative and recurrent bacteremia, respectively) and elevated glutamic oxaloacetic transaminase (GOT) levels. Recurrent-bacteremic episodes were associated with anemia (26% vs 14% and 9% in single bacteremia and culture negative, respectively), elevated GOT, low immunoglobulin M (IgM) titers (56% vs 89% and 99%, respectively), and lower levels of adequate treatment (74% vs 94% and 86%, respectively). In multivariate analyses, single bacteremia was associated with fever (odds ratio [OR], 3.595, compared with culture negative), while recurrent bacteremia was inversely associated with IgM titers ≥1:160 (OR, 0.022 and 0.226 compared with culture negative and single bacteremia, respectively) and fever (OR, 0.108 compared with single bacteremia). CONCLUSIONS Brucellosis episodes are commonly complicated with bacteremia. Single-bacteremic episodes were associated with high-grade fever and elevated liver enzymes, possibly indicating high bacterial virulence. Recurrent-bacteremic episodes were associated with poor treatment at initial diagnosis, along with low rates of fever, low IgM titers, and high anemia rates, possibly indicating impaired host response. Physicians should consider treatment modifications for suspected recurrent-bacteremic brucellosis, including monitoring treatment adherence, and possibly administering prolonged treatment.
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Affiliation(s)
- Shalom Ben-Shimol
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Salar Farahvar
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yariv Fruchtman
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Hemato-oncology Department, Soroka University Medical Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Naphtali Justman
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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29
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Lendner I, Justman N, Givon-Lavi N, Maimon MS, Kestenbaum I, Ben-Shimol S. Urine dipstick low sensitivity for UTI diagnosis in febrile infants*. Infect Dis (Lond) 2019; 51:764-771. [DOI: 10.1080/23744235.2019.1652339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Idan Lendner
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Naphtali Justman
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal S. Maimon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatric Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Inbal Kestenbaum
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatric Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ben-Shimol S, Bufman H, Sagi O, Shemer Y, Horev A, Justman N, Bazarsky E. A retrospective study on demographic and clinical characteristics of cutaneous leishmaniasis suspected cases in southern Israel, 2013-2016: Comparison between confirmed and negative cases. J Vector Borne Dis 2019; 56:159-165. [DOI: 10.4103/0972-9062.263723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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