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Tenne Y, Kahalon R, Daari L, Preis H, Eisner M, Chen R, Mor P, Grisaru Granovsky S, Samueloff A, Benyamini Y. Is Oxytocin Administration During Childbirth Associated With Increased Risk for Postpartum Posttraumatic Stress Symptoms?: A Preliminary Investigation. J Perinat Neonatal Nurs 2023:00005237-990000000-00026. [PMID: 38050984 DOI: 10.1097/jpn.0000000000000760] [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: 12/07/2023]
Abstract
INTRODUCTION Synthetic oxytocin is one of the most regularly administered medications to facilitate labor induction and augmentation. The present study examined the associations between oxytocin administration during childbirth and postpartum posttraumatic stress symptoms (PTSS). MATERIALS AND METHODS In a multicenter longitudinal study, women completed questionnaires during pregnancy and at 2 months postpartum (N = 386). PTSS were assessed with the Impact of Event Scale. Logistic regression was used to examine the difference in PTSS at Time 2 between women who received oxytocin and women who did not. RESULTS In comparison with women who did not receive oxytocin, women who received oxytocin induction were 3.20 times as likely to report substantial PTSS (P = .036, 95% confidence interval: 1.08-9.52), and women who received oxytocin augmentation were 3.29 times as likely to report substantial PTSS (P = .036, 95% confidence interval: 1.08-10.03), after controlling for being primiparous, preeclampsia, prior mental health diagnosis, mode of birth, postpartum hemorrhage, and satisfaction with staff. DISCUSSION Oxytocin administration was associated with a 3-fold increased risk of PTSS. The findings may reflect biological and psychological mechanisms related to postpartum mental health and call for future research to establish the causation of this relationship.
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Affiliation(s)
- Yaara Tenne
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Dr Tenne); The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel (Drs Tenne, Preis, and Benyamini and Ms Daari); The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel (Dr Kahalon); Department of Psychology, Stony Brook University, Stony Brook, New York (Dr Preis); Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Eisner and Chen); Department of Obstetrics and Gynecology, Medical Genetics Institute, Shaare Zedek Medical Center, and Hebrew University Medical School of Jerusalem, Jerusalem, Israel (Dr Mor); and Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, and Hebrew University Medical School of Jerusalem, Jerusalem, Israel (Drs Grisaru Granovsky and Samueloff)
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Talisman S, Guedalia J, Farkash R, Avitan T, Srebnik N, Kasirer Y, Schimmel MS, Ghanem D, Unger R, Granovsky SG. Neonatal intensive care admission for term neonates and subsequent childhood mortality: a retrospective linkage study. BMC Med 2023; 21:44. [PMID: 36747227 PMCID: PMC9903506 DOI: 10.1186/s12916-023-02744-7] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/18/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Neonatal intensive care unit (NICU) admission among term neonates is a rare event. The aim of this study was to study the association of the NICU admission of term neonates on the risk of long-term childhood mortality. METHODS A single-center case-control retrospective study between 2005 and 2019, including all in-hospital ≥ 37 weeks' gestation singleton live-born neonates. The center perinatal database was linked with the birth and death certificate registries of the Israeli Ministry of Internal Affairs. The primary aim of the study was to study the association between NICU admission and childhood mortality throughout a 15-year follow-up period. RESULTS During the study period, 206,509 births were registered; 192,527 (93.22%) term neonates were included in the study; 5292 (2.75%) were admitted to NICU. Throughout the follow-up period, the mortality risk for term neonates admitted to the NICU remained elevated; hazard ratio (HR), 19.72 [14.66, 26.53], (p < 0.001). For all term neonates, the mortality rate was 0.16% (n = 311); 47.9% (n = 149) of those had records of a NICU admission. The mortality rate by time points (ratio1:10,0000 births) related to the age at death during the follow-up period was as follows: 29, up to 7 days; 20, 7-28 days; 37, 28 days to 6 months; 21, 6 months to 1 year; 19, 1-2 years; 9, 2-3 years; 10, 3-4 years; and 27, 4 years and more. Following the exclusion of congenital malformations and chromosomal abnormalities, NICU admission remained the most significant risk factor associated with mortality of the study population, HRs, 364.4 [145.3; 913.3] for mortality in the first 7 days of life; 19.6 [12.1; 32.0] for mortality from 28 days through 6 months of life and remained markedly elevated after age 4 years; HR, 7.1 [3.0; 17.0]. The mortality risk related to the NICU admission event, adjusted for admission diagnoses remained significant; HR = 8.21 [5.43; 12.4]. CONCLUSIONS NICU admission for term neonates is a pondering event for the risk of long-term childhood mortality. This group of term neonates may benefit from focused health care.
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Affiliation(s)
- Shahar Talisman
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat-Gan, Israel
| | - Rivka Farkash
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Tehila Avitan
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel.
| | - Naama Srebnik
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Yair Kasirer
- Department of Pediatrics, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Michael S Schimmel
- Department of Pediatrics, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Donia Ghanem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat-Gan, Israel
| | - Sorina Grisaru Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
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Avni-Biron I, Mishael T, Zittan E, Livne-Margolin M, Zinger A, Tzadok R, Goldenberg R, Kopylov U, Ron Y, Hadar E, Helman S, Granovsky SG, Ollech JE, Arazi A, Farkash R, Pauker MH, Yanai H, Dotan I, Shitrit ABG. Ustekinumab during pregnancy in patients with inflammatory bowel disease: a prospective multicentre cohort study. Aliment Pharmacol Ther 2022; 56:1361-1369. [PMID: 36168705 DOI: 10.1111/apt.17224] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Received: 04/22/2022] [Revised: 05/17/2022] [Accepted: 09/05/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Women with inflammatory bowel diseases (IBD) often receive biologics to maintain remission during pregnancy. AIMS To assess maternal and neonatal outcomes in patients with IBD treated with ustekinumab (UST) during pregnancy METHODS: In a multicentre, prospective cohort study, we recruited women with IBD treated with UST during pregnancy between 2019 and 2021. Outcomes were compared among patients treated with UST, anti-tumour necrosis factor α, (anti-TNF) and non-UST, non-anti-TNF therapies. UST-treated patients were matched 1:2 to controls according to age, body mass index and parity. Newborns were followed up to 12 months. RESULTS We recruited 129 pregnant patients: UST 27; anti-TNF 52; non-UST, non-anti-TNF 50 (thiopurine or mesalazine 30, no therapy 20); Crohn's disease 25 (96.9%). Overall, pregnancy, neonatal and newborn outcomes were satisfactory, with no significant differences among patients treated with UST, anti-TNF and non-UST non-anti-TNF agents for obstetrical maternal complications [UST 3 (11.5%), anti TNF 12 (23.1%), non UST, non-anti-TNF 4 (8.2%), p = 0.095], pre-term delivery [1 (4.3%), 9 (18.4%), 4 (5.7%), p = 0.133], low birth weight [1 (4.2%), 5 (10.2%), 4 (8.3%), p = 0.679], or first year newborn hospitalisation [2 (9.1%), 4 (8.2%), 3 (6.1%), p = 0.885]. CONCLUSION Pregnant patients with IBD treated with UST demonstrated favourable pregnancy and neonatal outcomes that were comparable with those in patients treated with anti-TNF or other therapy. Data are reassuring for patients with IBD and their physicians when considering UST during pregnancy.
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Affiliation(s)
- Irit Avni-Biron
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Mishael
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eran Zittan
- Institute of Gastroenterology and Liver Diseases, IBD Unit, Emek Medical Center, Afula, Israel
| | - Moran Livne-Margolin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Adar Zinger
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Gastroenterology, Hadassah Medical Center, Jerusalem, Israel
| | - Roie Tzadok
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Rosie Goldenberg
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Uri Kopylov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Yulia Ron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maternal fetal medicine, Helen Schneider hospital of women, Rabin Medical Center, Petah Tikva, Israel
| | - Sarit Helman
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sorina Grisaru Granovsky
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob E Ollech
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Arazi
- Institute of Gastroenterology and Liver Diseases, IBD Unit, Emek Medical Center, Afula, Israel
| | - Rivka Farkash
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maor H Pauker
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Henit Yanai
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Dotan
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariella Bar-Gil Shitrit
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
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Avni Biron I, Maayan Y, Mishael T, Hadar E, Neeman M, Plitman Mayo R, Sela HY, Yagel S, Goldenberg R, Ben Ya’acov A, Grisaru Granovsky S, Ollech JE, Edelman-Klapper H, Rabinowitz KM, Pauker MH, Yanai H, Goren S, Cohen D, Dotan I, Bar-Gil Shitrit A. SARS-CoV-2 IgG Antibody Levels in Women with IBD Vaccinated during Pregnancy. Vaccines (Basel) 2022; 10:1833. [PMID: 36366342 PMCID: PMC9699106 DOI: 10.3390/vaccines10111833] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Regulatory agencies supported vaccination of pregnant women with SARS-CoV-2 mRNA vaccines, including patients with IBD. No data exist regarding these vaccines in IBD during pregnancy. AIM To assess the serologic response to two doses of the mRNA SARS-CoV-2 BNT162b2 vaccine in pregnant women with IBD vaccinated during pregnancy, compared to that of pregnant women without IBD, and non-pregnant women with IBD. METHODS Anti-spike antibody levels were assessed in all women and in cord blood of consenting women. RESULTS From December 2020 to December 2021, 139 women were assessed: pregnant with IBD-36, pregnant without IBD-61, and not pregnant with IBD-42. Antibodies were assessed in cords of two and nine newborns of women with and without IBD, respectively. Mean gestational ages at administration of the second vaccine doses were 22.0 weeks in IBD and 23.2 weeks in non-IBD, respectively. Mean (SD) duration from the second vaccine dose to serology analysis in pregnant women with IBD, without IBD, and in non-pregnant women with IBD was 10.6 (4.9), 16.4 (6.3), and 4.3 (1.0) weeks, respectively. All women mounted a serologic response. In multivariable analysis, no correlation was found between the specific group and antibody levels. In both pregnancy groups, an inverse correlation between antibody levels and the interval from the second vaccine dose was demonstrated. Cord blood antibody levels exceeded maternal levels in women with and without IBD. CONCLUSION All patients with IBD mounted a serologic response. The interval between vaccine administration to serology assessment was the most important factor determining antibody levels. A third vaccine dose should be considered in pregnant women with IBD vaccinated at early stages of pregnancy.
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Affiliation(s)
- Irit Avni Biron
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Yair Maayan
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
- Department of Military Medicine and “Tzameret”, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Medical Corps, Israel Defense Forces, Rehovot 7661041, Israel
| | - Tali Mishael
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
- Obstetrics and Gynecology Department, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva 49100, Israel
| | - Michal Neeman
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Romina Plitman Mayo
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Hen Y. Sela
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
- Obstetrics and Gynecology Department, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Simcha Yagel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
- Obstetrics and Gynecology Department, Mount Scopus Hadassah Medical Center, Jerusalem 9103102, Israel
| | - Rosalind Goldenberg
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
| | - Ami Ben Ya’acov
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
| | - Sorina Grisaru Granovsky
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
- Obstetrics and Gynecology Department, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Jacob E. Ollech
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Hadar Edelman-Klapper
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Keren Masha Rabinowitz
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv 69978, Israel
| | - Maor H. Pauker
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Henit Yanai
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Sophy Goren
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Dani Cohen
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Iris Dotan
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Ariella Bar-Gil Shitrit
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
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Talisman S, Guedalia J, Farkash R, Avitan T, Srebnik N, Kasirer Y, Schimmel MS, Ghanem D, Unger R, Grisaru Granovsky S. NICU Admission for Term Neonates in a Large Single-Center Population: A Comprehensive Assessment of Risk Factors Using a Tandem Analysis Approach. J Clin Med 2022; 11:jcm11154258. [PMID: 35893346 PMCID: PMC9332268 DOI: 10.3390/jcm11154258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Neonatal intensive care unit (NICU) admission among term neonates is associated with significant morbidity and mortality, as well as high healthcare costs. A comprehensive NICU admission risk assessment using an integrated statistical approach for this rare admission event may be used to build a risk calculation algorithm for this group of neonates prior to delivery. Methods: A single-center case−control retrospective study was conducted between August 2005 and December 2019, including in-hospital singleton live born neonates, born at ≥37 weeks’ gestation. Analyses included univariate and multivariable models combined with the machine learning gradient-boosting model (GBM). The primary aim of the study was to identify and quantify risk factors and causes of NICU admission of term neonates. Results: During the study period, 206,509 births were registered at the Shaare Zedek Medical Center. After applying the study exclusion criteria, 192,527 term neonates were included in the study; 5292 (2.75%) were admitted to the NICU. The NICU admission risk was significantly higher (ORs [95%CIs]) for offspring of nulliparous women (1.19 [1.07, 1.33]), those with diabetes mellitus or hypertensive complications of pregnancy (2.52 [2.09, 3.03] and 1.28 [1.02, 1.60] respectively), and for those born during the 37th week of gestation (2.99 [2.63, 3.41]; p < 0.001 for all), adjusted for congenital malformations and genetic syndromes. A GBM to predict NICU admission applied to data prior to delivery showed an area under the receiver operating characteristic curve of 0.750 (95%CI 0.743−0.757) and classified 27% as high risk and 73% as low risk. This risk stratification was significantly associated with adverse maternal and neonatal outcomes. Conclusion: The present study identified NICU admission risk factors for term neonates; along with the machine learning ranking of the risk factors, the highly predictive model may serve as a basis for individual risk calculation algorithm prior to delivery. We suggest that in the future, this type of planning of the delivery will serve different health systems, in both high- and low-resource environments, along with the NICU admission or transfer policy.
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Affiliation(s)
- Shahar Talisman
- Shaare Zedek Medical Center, Department of Obstetrics & Gynecology, School of Medicine, Hebrew University, Jerusalem 9103102, Israel; (S.T.); (R.F.); (N.S.); (D.G.); (S.G.G.)
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat-Gan 5290002, Israel; (J.G.); (R.U.)
| | - Rivka Farkash
- Shaare Zedek Medical Center, Department of Obstetrics & Gynecology, School of Medicine, Hebrew University, Jerusalem 9103102, Israel; (S.T.); (R.F.); (N.S.); (D.G.); (S.G.G.)
| | - Tehila Avitan
- Shaare Zedek Medical Center, Department of Obstetrics & Gynecology, School of Medicine, Hebrew University, Jerusalem 9103102, Israel; (S.T.); (R.F.); (N.S.); (D.G.); (S.G.G.)
- Correspondence: ; Tel.: +972-548000541
| | - Naama Srebnik
- Shaare Zedek Medical Center, Department of Obstetrics & Gynecology, School of Medicine, Hebrew University, Jerusalem 9103102, Israel; (S.T.); (R.F.); (N.S.); (D.G.); (S.G.G.)
| | - Yair Kasirer
- Shaare Zedek Medical Center, Department of Pediatrics, School of Medicine, Hebrew University, Jerusalem 9103102, Israel; (Y.K.); (M.S.S.)
| | - Michael S. Schimmel
- Shaare Zedek Medical Center, Department of Pediatrics, School of Medicine, Hebrew University, Jerusalem 9103102, Israel; (Y.K.); (M.S.S.)
| | - Dunia Ghanem
- Shaare Zedek Medical Center, Department of Obstetrics & Gynecology, School of Medicine, Hebrew University, Jerusalem 9103102, Israel; (S.T.); (R.F.); (N.S.); (D.G.); (S.G.G.)
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat-Gan 5290002, Israel; (J.G.); (R.U.)
| | - Sorina Grisaru Granovsky
- Shaare Zedek Medical Center, Department of Obstetrics & Gynecology, School of Medicine, Hebrew University, Jerusalem 9103102, Israel; (S.T.); (R.F.); (N.S.); (D.G.); (S.G.G.)
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Kofman R, Farkash R, Rottenstreich M, Samueloff A, Wasserteil N, Kasirer Y, Grisaru Granovsky S. Parity-Adjusted Term Neonatal Growth Chart Modifies Neonatal Morbidity and Mortality Risk Stratification. J Clin Med 2022; 11:jcm11113097. [PMID: 35683486 PMCID: PMC9181536 DOI: 10.3390/jcm11113097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/08/2022] [Accepted: 05/26/2022] [Indexed: 12/10/2022] Open
Abstract
Objective: To investigate the impact of parity-customized versus population-based birth weight charts on the identification of neonatal risk for adverse outcomes in small (SGA) or large for gestational age (LGA) infants compared to appropriate for gestational age (AGA) infants. Study design: Observational, retrospective, cohort study based on electronic medical birth records at a single center between 2006 and 2017. Neonates were categorized by birth weight (BW) as SGA, LGA, or AGA, with the 10th and 90th centiles as boundaries for AGA in a standard population-based model adjusted for gestational age and gender only (POP) and a customized model adjusted for gestational age, gender, and parity (CUST). Neonates defined as SGA or LGA by one standard and not overlapping the other, are SGA/LGA CUST/POP ONLY. Analyses used a reference group of BW between the 25th and 75th centile for the population. Results: Overall 132,815 singleton, live, term neonates born to mothers with uncomplicated pregnancies were included. The customized model identified 53% more neonates as SGA-CUST ONLY who had significantly higher rates of morbidity and mortality compared to the reference group (OR = 1.33 95% CI [1.16−1.53]; p < 0.0001). Neonates defined as LGA by the customized model (LGA-CUST) and AGA by the population-based model LGA-CUST ONLY had a significantly higher risk for morbidity compared to the reference (OR = 1.36 95% CI [1.09−1.71]; p = 0.007) or the LGA POP group. Neonatal mortality only occurred in the SGA and AGA groups. Conclusions: The application of a parity-customized only birth weight chart in a population of singleton, term neonates is a simple platform to better identify birth weight related neonatal risk for morbidity and mortality.
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Affiliation(s)
- Roie Kofman
- Department of Internal Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, Jerusalem 91120, Israel;
| | - Rivka Farkash
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (R.F.); (A.S.); (S.G.G.)
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (R.F.); (A.S.); (S.G.G.)
- Correspondence: ; Tel.: +972-2-655-5562; Fax: +972-2-666-6053
| | - Arnon Samueloff
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (R.F.); (A.S.); (S.G.G.)
| | - Netanel Wasserteil
- Department of Pediatrics, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (N.W.); (Y.K.)
| | - Yair Kasirer
- Department of Pediatrics, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (N.W.); (Y.K.)
| | - Sorina Grisaru Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (R.F.); (A.S.); (S.G.G.)
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Guedalia J, Farkash R, Wasserteil N, Kasirer Y, Rottenstreich M, Unger R, Grisaru Granovsky S. Primary risk stratification for neonatal jaundice among term neonates using machine learning algorithm. Early Hum Dev 2022; 165:105538. [PMID: 35026695 DOI: 10.1016/j.earlhumdev.2022.105538] [Citation(s) in RCA: 2] [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: 04/07/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neonatal jaundice occurs in approximately 60% of term newborns. Although risk factors for neonatal jaundice have been studied, all the suggested strategies are based on various newborn tests for bilirubin levels. We aim to stratify neonates into risk groups for clinically significant neonatal jaundice using a combined data analysis approach, without serum bilirubin evaluation. STUDY DESIGN Term (gestational week 37-42) neonates born in a single medical center, 2005-2018 were identified. Anonymized data were analyzed using machine learning. Thresholds for stratification into risk groups were established. Associations were evaluated statistically using neonates with and without clinically significant neonatal jaundice from the study population. RESULTS A total of 147,667 consecutive term live neonates were included. The machine learning diagnostic ability to evaluate the risk for neonatal jaundice was 0.748; 95% CI 0.743-0.754 (AUC). The most important factors were (in order of importance) maternal blood type, maternal age, gestational age at delivery, estimated birth weight, parity, CBC at admission, and maternal blood pressure at admission. Neonates were then stratified by risk: 61% (n = 90,140) were classed as low-risk, 39% (n = 57,527) as higher-risk. Prevalence of jaundice was 4.14% in the full cohort, and 1.47% and 8.29% in the low- and high-risk cohorts, respectively; OR 6.06 (CI: 5.7-6.45) for neonatal jaundice in high-risk group. CONCLUSION A population tailored "first step" screening policy using machine learning model presents potential of neonatal jaundice risk stratification for term neonates. Future development and validation of this computational model are warranted.
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Affiliation(s)
- Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat-Gan, Israel
| | - Rivka Farkash
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Netanel Wasserteil
- Department of Pediatrics, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Yair Kasirer
- Department of Pediatrics, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel.
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat-Gan, Israel
| | - Sorina Grisaru Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
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Rottenstreich A, Mishael T, Granovsky SG, Koslowsky B, Schweistein H, Abitbol G, Goldin E, Shitrit ABG. Clinical utility of fecal calprotectin in monitoring disease activity and predicting relapse in pregnant patients with inflammatory bowel diseases. Eur J Intern Med 2020; 77:105-110. [PMID: 32197833 DOI: 10.1016/j.ejim.2020.03.015] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/12/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Inflammatory bowel diseases (IBDs) are commonly diagnosed in reproductive-aged women and can substantially affect pregnancy outcomes. Non-invasive monitoring of IBD during the prenatal course is particularly challenging as traditional laboratory biomarkers are often affected by pregnancy-related physiologic changes. We aimed to evaluate the role of fecal calprotectin (FC) in monitoring disease activity and predicting relapse among IBD women throughout gestation. METHODS Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2014-2018. FC levels were determined with an enzyme-linked immunoassay. RESULTS A total of 265 FC (preconception, n = 41; 1st trimester, n = 48; 2nd trimester, n = 84; 3rd trimester, n = 76; postpartum, n = 16) measurements were obtained in 157 pregnancies. Higher FC concentrations were found in all time points in those with active disease than those in remission as assessed by either physician global assessment or disease clinical scores. FC levels were significantly correlated with physician global assessment and disease activity indices in all 5 periods of investigation. Excluding those with disease flare at the time of conception, disease relapse was encountered during the prenatal course in 40 (31.5%) of the remaining 127 pregnancies. FC levels were significantly higher in those who experienced a disease flare later in the course of gestation as compared to those who maintained clinical remission (median 341 vs. 224 μg/g, P = 0.04). CONCLUSION FC appears to be a reliable marker of ongoing disease activity throughout the prenatal course as well as a predictor of imminent disease flare among IBD pregnant patients.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Tali Mishael
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
| | - Sorina Grisaru Granovsky
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
| | - Benjamin Koslowsky
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
| | - Hagai Schweistein
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
| | - Guila Abitbol
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
| | - Eran Goldin
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
| | - Ariella Bar-Gil Shitrit
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
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Rottenstreich A, Fridman Lev S, Rotem R, Mishael T, Grisaru Granovsky S, Koslowsky B, Goldin E, Bar-Gil Shitrit A. Disease flare at prior pregnancy and disease activity at conception are important determinants of disease relapse at subsequent pregnancy in women with inflammatory bowel diseases. Arch Gynecol Obstet 2020; 301:1449-1454. [PMID: 32377786 DOI: 10.1007/s00404-020-05557-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Disease flare throughout gestation are not uncommon among women with inflammatory bowel diseases (IBD), and can substantially affect pregnancy outcomes. We aimed to evaluate the effect of prior pregnancy outcome on the risk of disease flare at subsequent pregnancy in women with IBD. METHODS Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2011-2018. RESULTS Overall, 476 IBD women were followed during the study period. Of them, 69 (14.5%) had two pregnancies throughout follow-up period and constituted the study cohort. Among these 69 women, 48 (69.6%) had Crohn's disease and 21 (30.4%) ulcerative colitis. The median interpregnancy interval was 20 [11-32] months. Overall, 34 (49.3%) women experienced disease flare at the subsequent pregnancy. In multivariate analysis, active disease at conception (odds ratio [95% CI]: 25.65 (3.05, 25.52), P < 0.001) and history of disease flare at the previous pregnancy (odds ratio [95% CI]: 4.21 (1.10, 16.58), P < 0.001) were the only independent predictors of disease relapse in current gestation. Rates of hospitalization during pregnancy (14.7% vs. 0, P = 0.02) and preterm delivery (32.4% vs. 5.7%, P = 0.006) were higher, and neonatal birth weight was lower (median 3039 vs. 3300 g, P = 0.03), in those with disease flare as compared to those with maintained remission. CONCLUSION History of disease relapse at previous gestation and periconception disease activity were found as important predictors of disease flare among IBD women. These data would facilitate adequate counseling and informed management decisions among reproductive-aged IBD women and their treating physicians.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
| | - Shira Fridman Lev
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Affiliated with the Medical School Hebrew University, Jerusalem, Israel
| | - Reut Rotem
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Affiliated with the Medical School Hebrew University, Jerusalem, Israel
| | - Tali Mishael
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Affiliated with the Medical School Hebrew University, Jerusalem, Israel
| | - Sorina Grisaru Granovsky
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Affiliated with the Medical School Hebrew University, Jerusalem, Israel
| | - Benjamin Koslowsky
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Affiliated with the Medical School Hebrew University, Jerusalem, Israel
| | - Eran Goldin
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Affiliated with the Medical School Hebrew University, Jerusalem, Israel
| | - Ariella Bar-Gil Shitrit
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Affiliated with the Medical School Hebrew University, Jerusalem, Israel
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Rottenstreich A, Diminsky M, Granovsky SG, Mishael T, Roth B, Spectre G, Kalish Y, Goldin E, Shitrit ABG. Assessment of the procoagulant potential and associated risk factors in pregnant patients with inflammatory bowel diseases. Eur J Intern Med 2019; 65:63-68. [PMID: 31036438 DOI: 10.1016/j.ejim.2019.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/01/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Both inflammatory bowel diseases (IBDs) and pregnancy are established risk factors for thrombotic complications, thus IBD pregnant patients can be considered at even greater risk for thrombosis as compared to non IBD pregnant women. We aimed to evaluate the risk factors associated with this prothrombotic tendency among IBD women throughout gestation. METHODS Women with IBD attending a multidisciplinary clinic for the preconception,antenatal and postnatal treatment were prospectively recruited during 2017-2018. Prothrombotic tendency was assessed by thrombin generation, a global marker of the activation of the coagulation system, expressed as the endogenous thrombin potential (ETP). RESULTS Overall, 145 IBD women and 50 healthy control subjects were enrolled in this study. Body mass index (BMI) and gestational age were comparable between the groups. ETP level was significantly higher in women with IBD compared to control subjects in all time period (P < .0001). Among women with IBD, ETP level positively correlated with disease activity, as assessed by physician global assessment (P = .005), gestational age (P < .0001), extra-intestinal involvement (P = .04), C-reactive protein level (P < .0001), erythrocyte sedimentation rate (P < .0001), white blood cell count (P = .008), BMI (P = .02) and was inversely correlated with hemoglobin level (P < .0001). ETP level did not correlate with the occurrence of adverse pregnancy outcomes. In a multivariate analysis, active disease (β = 0.20, P = .009), gestational age (β = 0.45, P < .0001), extra-intestinal involvement (β = 0.17, P = .02) and BMI (β = 0.15, P = .05) retained independent predictors of high ETP levels. CONCLUSION As determined by thrombin generation, the procoagulant potential among IBD pregnant patients was independently associated with disease activity, BMI and extra-intestinal disease involvement.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Maayan Diminsky
- Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sorina Grisaru Granovsky
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
| | - Tali Mishael
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
| | - Batia Roth
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Galia Spectre
- Institute of Hematology, Coagulation Unit, Beilinson Hospital, Rabin Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Yosef Kalish
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Goldin
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
| | - Ariella Bar-Gil Shitrit
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel
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Stanleigh J, Michaeli J, Armon S, Khatib F, Zuckerman B, Shaya M, Ioscovitch A, Shenfeld O, Greenblat D, Farkash R, Tevet A, Samueloff A, Grisaru Granovsky S. Maternal and neonatal outcomes following a proactive peripartum multidisciplinary management protocol for placenta creta spectrum as compared to the urgent delivery. Eur J Obstet Gynecol Reprod Biol 2019; 237:139-144. [PMID: 31039488 DOI: 10.1016/j.ejogrb.2019.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/18/2019] [Revised: 03/18/2019] [Accepted: 04/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherent and invasive placenta, termed Placenta Creta Spectrum (PCS), is associated with increased maternal morbidity and mortality. Incidence and risk factors for Placenta Creta are on the rise and call to optimize the obstetric care for this condition. OBJECTIVES We sought to compare maternal and neonatal outcomes between a ProActive Peripartum Multidisciplinary Approach (PAMA) as compared to the urgent management of the Placenta Creta Spectrum patients. STUDY DESIGN We conducted a single-center prospective observational study between 2005-2016. PCS patients registered with the implementation of a PAMA protocol 2014-2016 epoch(E2) were compared with the pre-PAMA 2005-2013 epoch(E1), managed by urgent team recruitment. The PAMA protocol is grounded on a continuum of care; A. Antenatal: PCS risk assessment based on clinical history and imaging, surgical, anesthesia, urological consults and designation of a dedicated team to be present at planned surgery; B. Delivery: planned at 34-35 weeks, massive transfusion protocol activation, insertion of ureteral catheters, vertical uterine incision, placement of vessel loops on the iliac vessels, avoidance of active placenta delivery, followed by the decision of hysterectomy or uterine repair; C. Post-operative care: intensive care admission. We evaluated maternal and neonatal outcomes. RESULTS During the study period 158,438 deliveries were registered in our institution; we identified a total of 72 PCS cases (0.05%): 50(69.4%) in E1 and 22 (30.6%) in E2. Patient characteristics were comparable among epochs. Significantly, patients in E2 vs. E1 had fewer events of massive blood transfusion 36.0% vs. 13.6%, p = 0.05; were transfused less RBC units: median 4 vs. 1.5, p = 0.012, had no transfusion-related respiratory complications and hemorrhage control re-laparotomies. Hysterectomy and hollow visceral injury rates were comparable (72% vs. 63.7%, 26% vs. 22%; respectively). The hysterectomy pathology assessment was available for the majority of the cases in both epochs; percreta diagnosis rate significantly increased in E2. The neonatal outcome was similar among the epochs. CONCLUSIONS Institution of a PAMA protocol for PCS resulted in eliminating the urgent deliveries and in reducing the associated significant hemorrhagic related maternal morbidity, with no increase in the rate of hysterectomy or adverse neonatal outcome.
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Affiliation(s)
- Jonathan Stanleigh
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Jennia Michaeli
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel.
| | - Shunit Armon
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Fayez Khatib
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Boris Zuckerman
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Michael Shaya
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Alexander Ioscovitch
- Department of Anesthesiology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Ofer Shenfeld
- Department of Urology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Dvora Greenblat
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Rivka Farkash
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Ahron Tevet
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated With The Hebrew University Hadassah School of Medicine, Jerusalem, Israel
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Bas-Lando M, Drukker L, Farkash R, Samueloff A, Granovsky SG. 676: Third stage of labor retained placental fragments: risks associated with an unsolved conundrum. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bas-Lando M, Haouzi F, Ioscovich A, Farkash R, Samueloff A, Granovsky SG. 677: Epidural analgesia is safe at TOLAC for the mother and neonate. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Drukker L, Hants Y, Farkash R, Samueloff A, Granovsky SG. 626: Gestational anemia is an independent risk factor for cesarean delivery and adverse perinatal outcome. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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