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Weissbach T, Lev S, Haimov A, Massarwa A, Shamay I, Plaschkes R, Assa L, Elkan-Miller T, Weisz B, Nardini G, Armon N, Sharon R, Mazaki Tovi S, Kassif E. The Hard Palate Sweep: a multiplanar 2-dimensional sonographic method for the prenatal detection of cleft palate. Am J Obstet Gynecol 2024; 230:356.e1-356.e10. [PMID: 37741531 DOI: 10.1016/j.ajog.2023.09.014] [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: 06/24/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Prenatal diagnosis of cleft palate is challenging. Numerous 2-dimensional and 3-dimensional methods have been proposed to assess the integrity of the fetal palate, yet detection rates remain relatively low. We propose the "Hard Palate Sweep," a novel 2-dimensional method that enables clear demonstration of the entire fetal palate throughout pregnancy, in a single sweep, avoiding acoustic shadows cast by surrounding bones. OBJECTIVE This study aimed to assess the feasibility and performance of the Hard Palate Sweep, performed throughout pregnancy. STUDY DESIGN This was a prospective cross-sectional study performed between 2018 and 2022 in pregnant patients referred for a routine or targeted anomaly scan between 13 and 40 weeks of gestation. The presence or absence of a cleft palate was determined using the "Hard Palate Sweep." This was compared with the postnatal palate integrity assessment. Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive values were calculated. Offline clips were reviewed by 2 investigators for the assessment of inter- and intraoperator agreement, using Cohen's kappa formula. The study protocol was approved by the institutional ethics committee. All participating patients were informed and provided consent. RESULTS A total of 676 fetuses were included in the study. The Hard Palate Sweep was successfully performed in all cases, and 19 cases were determined to have a cleft palate. Of these, 13 cases were excluded because postmortem confirmation was not performed, leaving 663 cases available for analysis. Six cases determined to have a cleft palate were confirmed postnatally. In 655 of 657 cases prenatally determined to have an intact palate, this was confirmed postnatally. In the 2 remaining cases, rare forms of cleft palate were diagnosed postnatally, rendering 75% sensitivity, 100% specificity, 100% positive predictive value, and 99.7% negative predictive value for the Hard Palate Sweep (P<.001). There was complete intra- and interoperator agreement (kappa=1; P<.0001). CONCLUSION The Hard Palate Sweep is a feasible and accurate method for prenatally detecting a cleft palate. It was successfully performed in all attempted cases between 13 and 40 weeks of gestation. This method is reproducible, offering high sensitivity and specificity. Implemented routinely, the Hard Palate Sweep is expected to increase the prenatal detection of cleft palate.
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Affiliation(s)
- Tal Weissbach
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shir Lev
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adina Haimov
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abeer Massarwa
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Shamay
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Roni Plaschkes
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Assa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Elkan-Miller
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Nardini
- Department of Plastic Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Noam Armon
- Department of Plastic and Aesthetic Surgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Roni Sharon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Shali Mazaki Tovi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Czeiger S, Weissbach T, Zloto K, Wiener A, Nir O, Massarwa A, Weisz B, Bartal MF, Ulman RY, Bart Y, Achiron R, Kivilevitch Z, Mazaki-Tovi S, Kassif E. Umbilical-portal-systemic venous shunt and intrauterine growth restriction: an inquiry from a prospective study. Am J Obstet Gynecol 2024:S0002-9378(24)00011-5. [PMID: 38218510 DOI: 10.1016/j.ajog.2024.01.003] [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: 09/08/2023] [Revised: 12/22/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The investigation of the fetal umbilical-portal venous system is based on the premise that congenital anomalies of this system may be related to adverse perinatal outcomes. Several small retrospective studies have reported an association between umbilical-portal-systemic venous shunts and intrauterine growth restriction. However, the prevalence of portosystemic shunts in the fetal growth restricted population is yet to be determined. OBJECTIVE The aims of this study were (1) to determine the prevalence of fetal umbilical-portal-systemic venous shunts in pregnancies complicated by intrauterine growth restriction and (2) to compare the perinatal and neonatal outcomes of pregnancies with intrauterine growth restriction with and without umbilical-portal-systemic venous shunts. STUDY DESIGN This was a prospective, cross-sectional study of pregnancies diagnosed with intrauterine growth restriction, as defined by the Society for Maternal-Fetal Medicine intrauterine growth restriction guidelines. All participants underwent a detailed anomaly scan, supplemented with a targeted scan of the fetal portal system. Venous shunts were diagnosed using color Doppler mode. The perinatal outcomes of pregnancies with intrauterine growth restriction with and without umbilical-portal-systemic venous shunts were compared. RESULTS A total of 150 cases with intrauterine growth restriction were recruited. The prevalence of umbilical-portal-systemic venous shunts in our cohort was 9.3% (n=14). When compared with the control group (intrauterine growth restriction without umbilical-portal-systemic venous shunts, n=136), the study group had a significantly lower mean gestational age at the time of intrauterine growth restriction diagnosis (29.7±5.6 vs 32.47±4.6 weeks of gestation; P=.036) and an earlier gestational age at delivery (33.50±6.0 vs 36.13±2.8; P=.005). The study group had a higher rate of fetal death (21.4% vs 0.7%; P<.001) and, accordingly, a lower rate of live births (71.4% vs 95.6%; P=.001). Additional associated fetal vascular anomalies were significantly more prevalent in the study group than in the control group (35.7% vs 4.4%; P≤.001). The rate of other associated anomalies was similar. The study group had a significantly lower rate of abnormal uterine artery Doppler indices (0% vs 40.4%; P=.011) and a higher rate of abnormal ductus venosus Doppler indices (64.3% vs 23%; P=.001). There were no cases of hypertensive disorders of pregnancy in the study group, whereas the control group had an incidence of 12.5% (P=.16). Other perinatal and neonatal outcomes were comparable. CONCLUSION Umbilical-portal-systemic venous shunt is a relatively common finding among fetuses with growth restriction. When compared with pregnancies with intrauterine growth restriction with a normal portal system, these pregnancies complicated by intrauterine growth restriction and an umbilical-portal-systemic venous shunt are associated with a different Doppler flow pattern, an increased risk for fetal death, earlier presentation of intrauterine growth restriction, a lower gestational age at delivery, additional congenital vascular anomalies, and a lower rate of pregnancy-induced hypertensive disorders. Meticulous sonographic evaluation of the portal system should be considered in the prenatal workup of intrauterine growth restriction, as umbilical-portal-systemic venous shunts may affect perinatal outcomes.
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Affiliation(s)
- Shelly Czeiger
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Department of Obstetrics and Gynecology, Mayanei HaYeshuha Medical Center, Bnei-Brak, Israel.
| | - Tal Weissbach
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Keren Zloto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariella Wiener
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Nir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abeer Massarwa
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Fishel Bartal
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rakefet Yoeli Ulman
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Bart
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuven Achiron
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Zvi Kivilevitch
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Massarwa A, Weissbach T, Hadi E, YuLzari V, Messing B, Adamo L, Elkan-Miller T, Achiron R, Kivilevich Z, Bart Y, Weisz B, Yoeli-Ullman R, Mazaki S, Kassif E. In-utero evaluation of the fetal umbilical-portal venous system among fetuses with persistent right umbilical vein: Two-and three-dimensional ultrasonographic study. Prenat Diagn 2024; 44:68-76. [PMID: 38172082 DOI: 10.1002/pd.6494] [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: 06/27/2023] [Revised: 11/02/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE The aim of this study was to describe the anatomy of the portal system in fetuses with persistent right umbilical vein (PRUV). METHODS Prospective observational study of fetuses diagnosed with PRUV. All patients underwent a comprehensive portal system anatomy scan supplemented by two-dimensional (2D) and three-dimensional (3D) color doppler modalities. RESULTS 29 fetuses with PRUV were studied. We perceived an identical anatomical pattern in 28 fetuses. The right umbilical vein drains to the portal sinus (future right portal vein, RPV), which has a configuration of a left portal vein (LPV) in the normal left portal system, with three emerging branches: inferior (RPVi), medial (RPVm) and superior (RPVs). The RPV then courses to the left, towards the stomach to the point of the bifurcation of the main portal vein (MPV) to become the left portal vein. The LPV has an RPV configuration in a normal portal system with anterior (LPVa) and posterior (RPVp) branches. This anatomical layout mimics a mirror image of the normal anatomy of left portal system. CONCLUSION PRUV has unique umbilical portal venous anatomy, which is a mirror image of the normal left portal system. It can be demonstrated prenatally and serve as an additional tool for prenatal diagnosis of PRUV.
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Affiliation(s)
- Abeer Massarwa
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Hadi
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered YuLzari
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Messing
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laura Adamo
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Tal Elkan-Miller
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Kivilevich
- Maccabi Health Services, Ultrasound Unit, The Negev Medical Center, Beer Sheba, Israel
| | - Yossi Bart
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rakefet Yoeli-Ullman
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shali Mazaki
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Diagnostic Ultrasound Unit, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rosen H, Gold-Zamir Y, Lopian M, Weissbach T, Kassif E, Weisz B. Accuracy of sonographic fetal weight estimation and prediction of birth-weight discordance in twin pregnancy: large single-center study. Ultrasound Obstet Gynecol 2023; 62:821-828. [PMID: 37265171 DOI: 10.1002/uog.26277] [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] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine the accuracy of sonographic fetal weight estimation in predicting birth weight (BW) and BW discordance in twin gestations, and to evaluate maternal and fetal characteristics that may affect the accuracy of this assessment. METHODS This was a retrospective cohort study of all twins delivered at a single tertiary medical center between 2010 and 2021. Twin gestations for which sonographic estimation of fetal weight was performed within the week preceding delivery were included. Statistical analysis was performed to evaluate the strength of the correlation between sonographic estimated fetal weight (EFW) and BW, and to determine the impact of maternal and fetal factors on the accuracy of sonographic estimation. RESULTS The study included 2154 twin pregnancies. There was a strong correlation between sonographic EFW and corresponding BW for all twins (r = 0.922; P < 0.001). Strong correlations were observed for both the presenting and non-presenting cotwin (r = 0.921 and r = 0.922, respectively; both P < 0.001), as well as the larger and smaller cotwin (r = 0.928 and r = 0.934, respectively; both P < 0.001). The overall mean ± SD absolute error of sonographic EFW was 7.41 ± 6.81%. This error was greater for the non-presenting cotwin compared with the presenting cotwin (7.99 ± 6.12% vs 7.17 ± 5.64%; P < 0.001), and for the smaller cotwin compared with the larger cotwin (8.56 ± 7.50% vs 6.58 ± 5.47%; P < 0.001). Advanced gestational age at scanning was correlated inversely with the mean absolute error of sonographic EFW. Multivariate logistic regression indicated that an earlier gestational age at scanning, being the non-presenting cotwin and being the smaller cotwin were independent risk factors for sonographic EFW inaccuracy. Pregnancies in which the presenting twin was estimated to be the smaller cotwin had twice the rate of false-positive BW discordance compared with pregnancies in which the presenting twin was estimated to be the larger cotwin (36.0% vs 13.0% for BW discordance > 15%, 35.0% vs 17.0% for BW discordance > 20% and 37.7% vs 12.1% for BW discordance > 25%; all P < 0.001). The error in sonographic EFW discordance was not related to chorionicity, the position of the presenting fetus or gestational age at the time of fetal weight estimation. CONCLUSIONS Sonographic estimation of fetal weight within 7 days before delivery accurately predicts BW in twin pregnancy. Sonographic EFW accuracy is reduced for the non-presenting twin, the smaller cotwin and when delivery occurs at an earlier gestational age. Sonographic estimation of fetal weight discordance is less accurate when the presenting twin is the smaller cotwin. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- H Rosen
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Gold-Zamir
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - M Lopian
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - T Weissbach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - E Kassif
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - B Weisz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
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Onn-Margalit L, Weissbach T, Gafner M, Fried S, Wandel A, Katorza E. [EXAMINING THE ASSOCIATION BETWEEN THE FETAL SUPRATENTORIAL BRAIN VOLUME AND THE SUBARACHNOID SPACE IN VARIOUS FETAL PATHOLOGIES USING MAGNETIC RESONANCE IMAGING]. Harefuah 2023; 162:644-649. [PMID: 38126147] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The subarachnoid space (SAS) is a potential space surrounding the brain where the cerebrospinal fluid (CSF) flows. Previous work demonstrated how the SAS width changes during pregnancy and measured the normal values per gestational week. OBJECTIVES Studying the ratio between the fetal brain volume (STV) and the SAS width (SS ratio), as measured via fetal magnetic resonance imaging (MRI) in different fetal pathologies - macrocephaly and microcephaly, and studying the correlation between this ratio and the gestational week. METHODS A retrospective study was conducted on 77 fetuses that underwent fetal MRI scans during gestational weeks 29-37, in three groups: 23 normocephaly, 27 macrocephaly, and 27 microcephaly. SAS width was measured in 10 points via fetal MRI scans, and a ratio was calculated between the width and STV. RESULTS The SS ratio is largest in microcephaly group and smallest in normocephaly group, with the macrocephaly group between them. All comparisons were statistically significant except between the macrocephaly and normocephaly groups. There was a strong positive correlation between SS ratio and week of gestation. CONCLUSIONS The SS ratio is statistically different between normocephalic fetuses and fetuses with macrocephaly or microcephaly. From week 29 this ratio enlarges with gestational age. DISCUSSION The SAS affects the fetal head circumference, an important parameter of fetal growth, thus we decided to study the SS ratio in pathologies of the head circumference. Previous work demonstrated how the STV and the SAS width expand starting at a specific gestational age, thus the gestational week also affects the SS ratio. Summary: The SS ratio is affected by pathologies of the fetal head circumference and by gestational age.
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Affiliation(s)
- Lior Onn-Margalit
- Arrow Program for Medical Research Education, Sheba Medical Center, Ramat-Gan, Israel
| | - Tal Weissbach
- Arrow Program for Medical Research Education, Sheba Medical Center, Ramat-Gan, Israel, Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Gafner
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shalev Fried
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Wandel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Department of Diagnostic Radiology, Shamir Medical Center, Israel
| | - Eldad Katorza
- Arrow Program for Medical Research Education, Sheba Medical Center, Ramat-Gan, Israel, Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
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Meyer R, Friedrich L, Plaschkes R, Toussia-Cohen S, Levin G, Weissbach T, Kassif E, Mashiach R. Clinical implications of a cesarean scar pregnancy sonographic evaluation and reporting system. Eur J Obstet Gynecol Reprod Biol 2023; 291:247-251. [PMID: 37944212 DOI: 10.1016/j.ejogrb.2023.11.003] [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: 07/31/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Recently, a new standardized sonographic evaluation system for cesarean scar pregnancies (CSP) was published. We aimed to evaluate the clinical outcomes of CSP cases according to the new sonographic evaluation and reporting system. STUDY DESIGN A retrospective study conducted at a single tertiary center. All CSPs between 1/2011 and 4/2022 were included. Cases were evaluated by expert sonographers and classified into three categories: 1) CSP in which the largest part of the gestational sac (GS) protrudes towards the uterine cavity; 2) CSP in which the largest part of the GS is embedded in the myometrium but does not cross the serosal contour; and 3) CSP in which the GS is partially located beyond the outer contour of the cervix or uterus.Baseline characteristics, management and outcomes were compared between the three categories. RESULTS Overall, 55 patients were diagnosed with CSP during the study period; 10 (18.1 %) type 1, 31 (56.3 %) type 2, and 14 (25.4 %) type 3. Baseline characteristics were similar among groups. Compared with type 2 and 3, patients diagnosed with CSP type 1 received less methotrexate treatment [83.9 % and 78.6 % vs. 40.0 %, respectively, p = 0.020]. The rates of need for invasive procedures, urgent procedures, major bleeding, length of hospitalization, and subsequent pregnancies were similar between groups. CONCLUSIONS No clinically significant differences were found between groups divided by the new standardized sonographic evaluation and reporting system for CSP in pregnancy characteristics, management, and subsequent pregnancy outcomes. Further investigation is required to enable informed management of CSP based on the new sonographic reporting system.
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Affiliation(s)
- Raanan Meyer
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, United States; The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Lior Friedrich
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Roni Plaschkes
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Shlomi Toussia-Cohen
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Gabriel Levin
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Tal Weissbach
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Kassif
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Lingam I, Okell J, Maksym K, Spencer R, Peebles D, Buquis G, Ambler G, Morsing E, Ley D, Singer D, Tenorio V, Dyer J, Ginsberg Y, Weissbach T, Huertas-Ceballos A, Marlow N, David A. Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study. Arch Dis Child Fetal Neonatal Ed 2023; 108:599-606. [PMID: 37185272 DOI: 10.1136/archdischild-2022-325285] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR). DESIGN The EVERREST (Do e s v ascular endothelial growth factor gene therapy saf e ly imp r ove outcome in seve r e e arly-onset fetal growth re st riction?) prospective multicentre study of women diagnosed with EP-FGR (singleton, estimated fetal weight (EFW) <3rd percentile, <600 g, 20+0-26+6 weeks of gestation). The UK subgroup of EP-FGR infants (<36 weeks) were sex-matched and gestation-matched to appropriate for age (AGA) infants born in University College London Hospital (1:2 design, EFW 25th-75th percentile). SETTING Four tertiary perinatal units (UK, Germany, Spain, Sweden). MAIN OUTCOMES Antenatal and postnatal mortality, bronchopulmonary dysplasia (BPD), sepsis, surgically treated necrotising enterocolitis (NEC), treated retinopathy of prematurity (ROP). RESULTS Of 135 mothers recruited with EP-FGR, 42 had a stillbirth or termination of pregnancy (31%) and 93 had live births (69%). Postnatal genetic abnormalities were identified in 7/93 (8%) live births. Mean gestational age at birth was 31.4 weeks (SD 4.6). 54 UK-born preterm EP-FGR infants (<36 weeks) were matched to AGA controls. EP-FGR was associated with increased BPD (43% vs 26%, OR 3.6, 95% CI 1.4 to 9.4, p=0.01), surgical NEC (6% vs 0%, p=0.036) and ROP treatment (11% vs 0%, p=0.001). Mortality was probably higher among FGR infants (9% vs 2%, OR 5.0, 95% CI 1.0 to 25.8, p=0.054). FGR infants more frequently received invasive ventilation (65% vs 50%, OR 2.6, 95% CI 1.1 to 6.1, p=0.03), took longer to achieve full feeds and had longer neonatal stays (median difference 6.1 days, 95% CI 3.8 to 8.9 and 19 days, 95% CI 9 to 30 days, respectively, p<0.0001). CONCLUSIONS Mortality following diagnosis of EP-FGR is high. Survivors experience increased neonatal morbidity compared with AGA preterm infants. TRIAL REGISTRATION NUMBER NCT02097667.
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Affiliation(s)
- Ingran Lingam
- EGA Institute for Women's Health, University College London, London, UK
- Woodland Neonatal Unit, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK
| | - Jade Okell
- EGA Institute for Women's Health, University College London, London, UK
| | - Katarzyna Maksym
- EGA Institute for Women's Health, University College London, London, UK
| | - Rebecca Spencer
- EGA Institute for Women's Health, University College London, London, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Donald Peebles
- Neonatal Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Gina Buquis
- EGA Institute for Women's Health, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Eva Morsing
- Department of Paediatrics, Lund University, Lund, Sweden
| | - David Ley
- Department of Paediatrics, Lund University, Lund, Sweden
| | - Dominique Singer
- Division of Neonatology and Pediatric Critical Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Violeta Tenorio
- Institut D'Investigacions Biomèdiques August Pi í Sunyer, University of Barcelona, Barcelona, Spain
| | - Jade Dyer
- EGA Institute for Women's Health, University College London, London, UK
| | - Yuval Ginsberg
- EGA Institute for Women's Health, University College London, London, UK
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Tal Weissbach
- EGA Institute for Women's Health, University College London, London, UK
- Institute of Obstetrical and Gynecological Imaging, Diagnostic Ultrasound Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Angela Huertas-Ceballos
- Neonatal Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil Marlow
- EGA Institute for Women's Health, University College London, London, UK
| | - Anna David
- EGA Institute for Women's Health, University College London, London, UK
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8
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Steg Saban O, Weissbach T, Achiron R, Pekar Zlotin M, Haberman Y, Anis Heusler A, Kassif E, Weiss B. Intrahepatic portosystemic shunts, from prenatal diagnosis to postnatal outcome: a retrospective study. Arch Dis Child 2023; 108:910-915. [PMID: 37474281 DOI: 10.1136/archdischild-2023-325424] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Congenital intrahepatic portosystemic shunts (IHPSS) are rare vascular malformations resulting in blood bypassing the liver to the systemic circulation. Previous studies included symptomatic patients diagnosed postnatally, but the outcome of IHPSS diagnosed prenatally is rarely reported. We present a cohort of children prenatally diagnosed with IHPSS and report their natural course and outcome. METHODS AND DESIGN This was a retrospective study of all fetal cases diagnosed by ultrasound with IHPSS between 2006 and 2019 at a single tertiary centre which were prospectively followed up at the paediatric gastroenterology unit. The postnatal outcome was compared between patients with a single versus multiple intrahepatic shunts. RESULTS Twenty-six patients (70.3% boys) were included in the study, of them, eight (30.8%) patients had multiple intrahepatic shunts. The median gestational age at diagnosis was 29.5 weeks. Growth restriction affected 77% of the cohort. Postnatally, spontaneous shunt closure occurred in 96% of patients at a median age of 7.5 months (IQR 2.2-20 months). Failure to thrive (FTT) and mild developmental delay were observed in eight (30.8%) and seven (26.9%) patients, respectively. FTT was significantly more prevalent in patients with multiple shunts compared with patients with a single shunt (62.5% vs 16.7%, p=0.02); however, the rate of shunt closure and age at time of closure were similar between these groups. All patients survived with limited to no sequelae. CONCLUSIONS IHPSS usually close spontaneously by 2 years of age. Children with prenatally detected IHPSS may develop FTT and mild developmental delay. Close surveillance at a paediatric gastroenterology unit may be beneficial.
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Affiliation(s)
- Or Steg Saban
- Pediatrics B Department, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Reuven Achiron
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Marina Pekar Zlotin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Yitzhak Shamir Medical Center Assaf Harofeh, Tzrifin, Israel
| | - Yael Haberman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology and Nutrition Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Anis Heusler
- Department of OBGYN, Laniado Hospital, Netanya, Israel
- The Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eran Kassif
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Batia Weiss
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology and Nutrition Unit, Sheba Medical Center, Tel Hashomer, Israel
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9
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Spencer R, Maksym K, Hecher K, Maršál K, Figueras F, Ambler G, Whitwell H, Nené NR, Sebire NJ, Hansson SR, Diemert A, Brodszki J, Gratacós E, Ginsberg Y, Weissbach T, Peebles DM, Zachary I, Marlow N, Huertas-Ceballos A, David AL. Maternal PlGF and umbilical Dopplers predict pregnancy outcomes at diagnosis of early-onset fetal growth restriction. J Clin Invest 2023; 133:e169199. [PMID: 37712421 PMCID: PMC10503803 DOI: 10.1172/jci169199] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/27/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUNDSevere, early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, thus preventing accurate patient counseling. We investigated the use of maternal serum protein and ultrasound measurements at diagnosis to predict fetal or neonatal death and 3 secondary outcomes: fetal death or delivery at or before 28+0 weeks, development of abnormal umbilical artery (UmA) Doppler velocimetry, and slow fetal growth.METHODSWomen with singleton pregnancies (n = 142, estimated fetal weights [EFWs] below the third centile, less than 600 g, 20+0 to 26+6 weeks of gestation, no known chromosomal, genetic, or major structural abnormalities) were recruited from 4 European centers. Maternal serum from the discovery set (n = 63) was analyzed for 7 proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease, and 5 proteins identified through pooled liquid chromatography and tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n = 60), with final models calculated from combined data.RESULTSThe most discriminative model for fetal or neonatal death included the EFW z score (Hadlock 3 formula/Marsal chart), gestational age, and UmA Doppler category (AUC, 0.91; 95% CI, 0.86-0.97) but was less well calibrated than the model containing only the EFW z score (Hadlock 3/Marsal). The most discriminative model for fetal death or delivery at or before 28+0 weeks included maternal serum placental growth factor (PlGF) concentration and UmA Doppler category (AUC, 0.89; 95% CI, 0.83-0.94).CONCLUSIONUltrasound measurements and maternal serum PlGF concentration at diagnosis of severe, early-onset FGR predicted pregnancy outcomes of importance to patients and clinicians.TRIAL REGISTRATIONClinicalTrials.gov NCT02097667.FUNDINGThe European Union, Rosetrees Trust, Mitchell Charitable Trust.
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Affiliation(s)
- Rebecca Spencer
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Kasia Maksym
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karel Maršál
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Francesc Figueras
- Institut D’Investigacions Biomèdiques August Pi í Sunyer, University of Barcelona, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, United Kingdom
| | - Harry Whitwell
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
- National Phenome Centre and Imperial Clinical Phenotyping Centre, Department of Metabolism, Digestion and Reproduction and
- Section of Bioanalytical Chemistry, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Nuno Rocha Nené
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
| | - Neil J. Sebire
- Population, Policy and Practice Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Stefan R. Hansson
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Brodszki
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Eduard Gratacós
- Institut D’Investigacions Biomèdiques August Pi í Sunyer, University of Barcelona, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
| | - Yuval Ginsberg
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
- Department of Obstetrics and Gynecology, Rambam Medical Centre, Haifa, Israel
| | - Tal Weissbach
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
- Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Tel Aviv, Israel
| | - Donald M. Peebles
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
| | - Ian Zachary
- Division of Medicine, Faculty of Medical Sciences, University College London, United Kingdom
| | - Neil Marlow
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
| | - Angela Huertas-Ceballos
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Anna L. David
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
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10
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Weissbach T, Hausman-Kedem M, Yanay Z, Meyer R, Bar-Yosef O, Leibovitch L, Berkenstadt M, Chorin O, Shani H, Massarwa A, Achiron R, Weisz B, Sharon R, Mazaki-Tovi S, Kassif E. Congenital hypotonia: systematic approach for prenatal detection. Ultrasound Obstet Gynecol 2023; 62:94-105. [PMID: 36779229 DOI: 10.1002/uog.26178] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/07/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Congenital hypotonic conditions are rare and heterogeneous, and some are severely debilitating or lethal. Contrary to its prominent postnatal manifestation, the prenatal presentation of hypotonia is frequently subtle, inhibiting prenatal detection. We aimed to characterize the prenatal sonographic manifestation of congenital hypotonia throughout pregnancy, evaluate the yield of diagnostic tests and propose diagnostic models to increase its prenatal detection. METHODS This was a retrospective observational study of singleton pregnancies with congenital hypotonia, diagnosed either prenatally or immediately after birth, at a single tertiary center between the years 2012 and 2020. Prenatally, hypotonia was diagnosed if a fetus showed sonographic or clinical signs suggestive of hypotonia and had a confirmed underlying genetic condition, or in the absence of a known genetic abnormality if the fetus exhibited multiple prominent signs suggestive of hypotonia. Postnatally, it was diagnosed in neonates displaying reduced muscle tone leading to reduced spontaneous movement, reduced swallowing or feeding difficulty. We reviewed the medical records of pregnant patients carrying fetuses subsequently diagnosed with congenital hypotonia and assessed the yield of ultrasound scans, fetal magnetic resonance imaging, computed tomography and genetic tests. The detection rate of sonographic signs suggesting fetal hypotonia was calculated. The prevalence of non-specific signs, including polyhydramnios, persistent breech presentation, intrauterine growth restriction and maternal perception of reduced fetal movement, were compared between the study group and the local liveborn singleton population. Potential detection rates of different theoretical semiotic diagnostic models, differing in the threshold for referral for a targeted scan, were assessed based on the cohort's data. RESULTS The study group comprised 26 cases of congenital hypotonia, of which 10 (38.5%) were diagnosed prenatally, and the controls included 95 105 singleton live births, giving a prevalence of congenital hypotonia of 1:3658. Nuchal translucency thickness and the early anomaly scan at 13-17 weeks were normal in all 22 and 23 cases, respectively, in which this was performed. The mid-trimester scan performed at 19-25 weeks was abnormal in four of 24 (16.7%) cases. The overall prenatal detection rate of congenital hypotonic conditions in our cohort was 38.5%. Only cases which underwent a targeted scan were detected and, among the 16 cases which underwent this scan, the prenatal detection rate was 62.5% compared with 0% in pregnancies that did not undergo this scan (P = 0.003). An abnormal genetic diagnosis was obtained in 21 (80.8%) cases using the following modalities: chromosomal microarray analysis (CMA) in two (9.5%), whole-exome sequencing (WES) in 14 (66.7%) and methylation analysis in five (23.8%). CMA was abnormal in 8% (2/25) of the cases and WES detected a causative genetic mutation in 87.5% (14/16) of the cases in which these were performed. Comparison of non-specific signs in the study group with those in the local singleton population showed that hypotonic fetuses had significantly more polyhydramnios (64.0% vs 3.0%, P < 0.0001), persistent breech presentation (58.3% vs 4.2%, P < 0.0001), intrauterine growth restriction (30.8% vs 3.0%, P < 0.0001) and maternal perception of reduced fetal movement (32.0% vs 4.7%, P < 0.0001). Prenatally, the most commonly detected signs supporting a diagnosis of hypotonia were structural anomaly (62.5%, 10/16), reduced fetal movement (46.7%, 7/15), joint contractures (46.7%, 7/15) and undescended testes ≥ 30 weeks (42.9%, 3/7 males). Proposed diagnostic strategies that involved performing a targeted scan for a single non-specific ultrasound sign or two such signs, and then carrying out a comprehensive genetic evaluation for any additional sign, offered theoretical detection rates in our cohort of 88.5% and 57.7%, respectively. CONCLUSIONS Congenital hypotonic conditions are rare and infrequently detected prenatally. Sonographic signs are visible from the late second trimester. A targeted scan increases prenatal detection significantly. Comprehensive genetic testing, especially WES, is the cornerstone of diagnosis in congenital hypotonia. Theoretical diagnostic models which may increase prenatal detection are provided. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Weissbach
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Hausman-Kedem
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Z Yanay
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Schneider Children's Medical Center, Petach Tikva, Israel
| | - R Meyer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - O Bar-Yosef
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology, Safra Children's Hospital, Sheba, Tel Hashomer, Israel
| | - L Leibovitch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neonatal Intensive Care Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - M Berkenstadt
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Danek Institute of Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - O Chorin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Danek Institute of Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - H Shani
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Danek Institute of Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - A Massarwa
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Achiron
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Weisz
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Sharon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel
| | - S Mazaki-Tovi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - E Kassif
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Wandel A, Weissbach T, Katorza E, Ziv-Baran T. Subarachnoid Space Measurements in Apparently Healthy Fetuses Using MR Imaging. AJNR Am J Neuroradiol 2023; 44:716-721. [PMID: 37202119 PMCID: PMC10249698 DOI: 10.3174/ajnr.a7864] [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: 02/11/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND PURPOSE The fetal subarachnoid space size serves as an indicator of normal brain development. The subarachnoid space is commonly measured by an ultrasound examination. Introduction of MR imaging for fetal brain evaluation enables standardization of MR imaging-driven subarachnoid space parameters for a more accurate evaluation. This study aimed to determine the normal range of MR imaging-derived subarachnoid space size in fetuses according to gestational age. MATERIALS AND METHODS A cross-sectional study based on a retrospective assessment of randomly selected brain MR images of apparently healthy fetuses performed between 2012 and 2020 at a large tertiary medical center was performed. Demographic data were collected from the mothers' medical records. Subarachnoid space size was measured at 10 reference points using the axial and coronal planes. Only MR imaging scans obtained between weeks 28 and 37 of pregnancy were included. Scans with low-quality images, multiple pregnancy, and cases with intracranial pathologic findings were excluded. RESULTS Overall, 214 apparently healthy fetuses were included (mean maternal age, 31.2 [SD, 5.4] years). Good interobserver and intraobserver agreement was observed (intraclass correlation coefficient > 0.75 for all except 1 parameter). For each gestational week, the 3rd, 15th, 50th, 85th, and 97th percentiles of each subarachnoid space measurement were described. CONCLUSIONS MR imaging-derived subarachnoid space values at a specific gestational age provide reproducible measurements, probably due to the high resolution of MR imaging and adherence to the true radiologic planes. Normal values for brain MR imaging could provide valuable reference information for assessing brain development, thus being an important tool in the decision-making process of both clinicians and parents.
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Affiliation(s)
- A Wandel
- From the Sackler School of Medicine (A.W., T.W., E.K.)
- Department of Diagnostic Radiology (A.W.), Shamir Medical Center, Zerifin, Israel
| | - T Weissbach
- From the Sackler School of Medicine (A.W., T.W., E.K.)
- Antenatal Diagnostic Unit (T.W., E.K.)
| | - E Katorza
- From the Sackler School of Medicine (A.W., T.W., E.K.)
- Antenatal Diagnostic Unit (T.W., E.K.)
- Department of Obstetrics and Gynecology, and Gertner Institute for Epidemiology and Health Policy Research (E.K.), Sheba Medical Center, Tel HaShomer, Israel
| | - T Ziv-Baran
- School of Public Health (T.Z.-B.), Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Levin G, Ohayon A, Weissbach T, Burke YZ, Meyer R. Ectopic first pregnancy treated by methotrexate versus salpingectomy-Maternal and perinatal outcomes in a subsequent pregnancy: A retrospective study. Int J Gynaecol Obstet 2023; 160:823-828. [PMID: 35871755 PMCID: PMC10087190 DOI: 10.1002/ijgo.14365] [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: 03/11/2022] [Revised: 06/30/2022] [Accepted: 07/17/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study obstetric outcomes of a second pregnancy among women with a first ectopic pregnancy (EP) treated with methotrexate compared with laparoscopic salpingectomy. METHODS A retrospective cohort study including all women with a first EP and a following pregnancy that concluded by delivery at ≥24 weeks of gestation between March 2011 and April 2021. Second pregnancy outcomes were compared between women treated with methotrexate and those treated with salpingectomy in their first pregnancy. RESULTS Overall, 125 women were included, of which 64 (51.2%) were treated with methotrexate and 61 (48.8%) were treated with salpingectomy. In women treated with salpingectomy, the proportion of women conceiving by in vitro fertilization and those with measured gestational sac diameter or β-subunit human chorionic gonadotropin was higher. The proportion of women conceiving by in vitro fertilization in their second pregnancy was higher in the salpingectomy group (55.2% versus 18.0%, P < 0.001). All maternal and neonatal outcomes were similar in both groups. The rate of low birth weight < 2500 g was 7.8% in the methotrexate group versus 18% in the salpingectomy group (P = 0.111). CONCLUSION Maternal and neonatal outcomes of a second pregnancy among women treated for EP in their first pregnancy are similar in women treated by methotrexate and those treated by salpingectomy.
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Affiliation(s)
- Gabriel Levin
- Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Aviran Ohayon
- Faculty of Medicine, St. George's University of London, London, UK
| | - Tal Weissbach
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Yechiel Z Burke
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Raanan Meyer
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat-Gan, Israel
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13
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Weissbach T, Massarwa A, Hadi E, Lev S, Haimov A, Katorza E, Brenner-Weissmann A, Krampl-Bettelheim E, Kasprian G, Sharon R, Achiron R, Weisz B, Kivilevitch Z, Kassif E. Early Fetal Corpus Callosum: Demonstrating Normal Growth and Detecting Pathologies in Early Pregnancy. AJNR Am J Neuroradiol 2023; 44:199-204. [PMID: 36657951 PMCID: PMC9891336 DOI: 10.3174/ajnr.a7757] [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: 09/14/2022] [Accepted: 12/10/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE A malformed corpus callosum carries a risk for abnormal neurodevelopment. The advent of high-frequency transducers offers the opportunity to assess corpus callosum development in early pregnancy. The aim of the study was to construct a reference chart of the fetal corpus callosum length on ultrasound between 13 and 19 weeks of gestation and to prospectively examine growth patterns in pathologic cases. MATERIALS AND METHODS We performed a prospective cross-sectional study between 2020 and 2022 in well-dated, low-risk, singleton pregnancies between 13 and 19 weeks of gestation. A standardized image was obtained in the midsagittal plane. Imaging criteria were used as a confirmation of the early corpus callosum. Measurements were taken by 4 trained sonographers. Intra- and interobserver variability was assessed. Corpus callosum length in centiles were calculated for each gestational week. RESULTS One hundred eighty-seven fetuses were included in the study. All cases met inclusion criteria. At 13 weeks of gestation, the margins of the early corpus callosum were sufficiently clear to be measured in 80% (20/25) of fetuses. A cubic polynomial regression model best described the correlation between corpus length and gestational age. The correlation coefficient (r 2) was 0.929 (P < .001). Intra- and interobserver variability had high interclass correlation coefficients (>0.99). Presented is the earliest published case of agenesis of corpus callosum and a case of dysgenetic corpus callosum in Rubinstein-Taybi syndrome. CONCLUSIONS Provided is a nomogram of the early fetal corpus callosum. Applying imaging criteria helped to identify a case of complete agenesis of the corpus callosum as early as 14 weeks.
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Affiliation(s)
- T Weissbach
- From The Institute of Obstetrical and Gynecological Imaging (T.W., A.M., E.H., E. Katorza, A.B.-W., R.A., B.W., E. Kassif)
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
| | - A Massarwa
- From The Institute of Obstetrical and Gynecological Imaging (T.W., A.M., E.H., E. Katorza, A.B.-W., R.A., B.W., E. Kassif)
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
| | - E Hadi
- From The Institute of Obstetrical and Gynecological Imaging (T.W., A.M., E.H., E. Katorza, A.B.-W., R.A., B.W., E. Kassif)
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
| | - S Lev
- Department of Obstetrics and Gynecology (S.L., A.H.)
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
| | - A Haimov
- Department of Obstetrics and Gynecology (S.L., A.H.)
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
| | - E Katorza
- From The Institute of Obstetrical and Gynecological Imaging (T.W., A.M., E.H., E. Katorza, A.B.-W., R.A., B.W., E. Kassif)
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
| | - A Brenner-Weissmann
- From The Institute of Obstetrical and Gynecological Imaging (T.W., A.M., E.H., E. Katorza, A.B.-W., R.A., B.W., E. Kassif)
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
| | | | - G Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy (G.K.), Medical University of Vienna, Vienna, Austria
| | - R Sharon
- Department of Neurology (R.S.), Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
| | - R Achiron
- From The Institute of Obstetrical and Gynecological Imaging (T.W., A.M., E.H., E. Katorza, A.B.-W., R.A., B.W., E. Kassif)
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
| | - B Weisz
- From The Institute of Obstetrical and Gynecological Imaging (T.W., A.M., E.H., E. Katorza, A.B.-W., R.A., B.W., E. Kassif)
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
| | - Z Kivilevitch
- Women's Ultrasound Unit (Z.K.), Maccabi Health Services, Negev Medical Center, Beer-Sheva, Israel
| | - E Kassif
- From The Institute of Obstetrical and Gynecological Imaging (T.W., A.M., E.H., E. Katorza, A.B.-W., R.A., B.W., E. Kassif)
- Sackler School of Medicine (T.W., A.M., E.H., S.L., A.H., E. Katorza, A.B.-W., R.S., R.A., B.W., E. Kassif), Tel Aviv University, Tel Aviv, Israel
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Koren N, Shust-Barequet S, Weissbach T, Raviv O, Abu Snenh S, Abraham E, Cahan T, Eisenberg V, Yulzari V, Hadi E, Adamo L, Mazaki Tovi S, Achiron R, Kivilevitch Z, Weisz B, Kassif E. Fetal Micro and Macroglossia: Defining Normal Fetal Tongue Size. J Ultrasound Med 2023; 42:59-70. [PMID: 35396717 DOI: 10.1002/jum.15983] [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] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Abnormal fetal tongue size is a phenotypic feature of various syndromes including Beckwith-Wiedemann, Pierre-Robin, oromandibular limb hypoplasia, chromosomal aberrations, etc. Current data regarding normal fetal tongue size are limited. Hence, micro/macroglossia are subjectively determined. The aim of the study was to construct a contemporary fetal tongue nomogram and to assess its clinical contribution. METHODS A prospective cross-sectional study was performed in well dated, low risk, singleton pregnancies. Fetal tongues were measured by 5 trained sonographers. Highest quality images were selected. Intra- and interobserver variability was assessed. Tongue length, width, area, and circumference 1st to 99th centiles were calculated for each gestational week. Based on the normal tongue size charts, we created a Tongue Centile Calculator. RESULTS Over 18 months, 664 tongue measurements were performed. A cubic polynomial regression model best described the correlation between tongue size and gestational age. The correlation coefficient (r2 ) was 0.934, 0.932, 0.925, and 0.953 for tongue length, width, area, and circumference, respectively (P < .001). Intra- and interobserver variability had high interclass correlation coefficients (>0.9). Using the new charts, we were able to identify 2 cases of macroglossia, subsequently diagnosed with Beckwith-Wiedemann, and 4 cases of microglossia, 3 associated with Pierre-Robin sequence, and 1 associated with persistent buccopharyngeal membrane. CONCLUSIONS We present novel fetal tongue size charts from 13 to 40 weeks of gestation. Clinical application of these nomograms may be beneficial in the prenatal diagnosis of syndromes or malformations associated with abnormal fetal tongue size.
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Affiliation(s)
- Natalie Koren
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Shust-Barequet
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Tal Weissbach
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Oshrat Raviv
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samar Abu Snenh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Efrat Abraham
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Cahan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Vered Eisenberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Vered Yulzari
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Efrat Hadi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Laura Adamo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Shali Mazaki Tovi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Reuven Achiron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Zvi Kivilevitch
- Women's Ultrasound Unit, Maccabi Health Services, Negev Medical Center, Beer-Sheva, Israel
| | - Boaz Weisz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
| | - Eran Kassif
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Institute of Obstetrical and Gynecological Imaging, Tel-Hashomer, Ramat Gan, Israel
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Weissbach T, Kushnir A, Yousefi S, Massarwa A, Leibovitch L, Frank DD, Kidron D, Achiron R, Meyer R, Weisz B, Mazaki Tovi S, Kassif E. The prenatal detection of distal tracheoesophageal fistulas in fetuses diagnosed with esophageal atresia. Am J Obstet Gynecol 2022; 227:897.e1-897.e9. [PMID: 35940225 DOI: 10.1016/j.ajog.2022.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Esophageal atresia is a major anomaly of varying severity. The complexity of surgical correction depends on the presence of a distal fistula. OBJECTIVE This study aimed to determine the feasibility and accuracy of prenatal ultrasound detection of the distal fistula in fetuses diagnosed with esophageal atresia. STUDY DESIGN This was an observational study conducted at a single tertiary care center between 2019 and 2021. Included were pregnant patients carrying a fetus prenatally diagnosed with esophageal atresia that was confirmed postnatally during corrective surgery or at postmortem autopsy. During the scan, the performing investigator determined the presence or absence of a distal fistula by scanning the location of the lower esophagus during fetal breathing. Cases in which the lower esophagus was observed distending with amniotic fluid during breathing were deemed "fistula present," and the remaining cases "fistula absent." Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive value were calculated. The offline clips and images were reviewed by 2 investigators for the assessment of interoperator agreement using Cohen's Kappa formula. RESULTS Included were 16 fetuses with esophageal atresia scanned between 2019 and 2021. All fetuses were successfully scanned with sufficient resolution of the area of interest during at least 3 cycles of breathing. It took a median of 8.5 minutes to determine the presence or absence of a distal fistula. The feasibility of the test was 100% (16/16). The test's sensitivity, specificity, and positive and negative predictive values were 80% (95% confidence interval, 55-100), 100% (95% confidence interval, 60-100), 100% (95% confidence interval, 65-100), and 75% (95% confidence interval, 45-100), respectively. The Cohen's Kappa for interoperator agreement was calculated to be 1, P<.001, corresponding to a "perfect" level of agreement. CONCLUSION Distal fistulas in esophageal atresia can be demonstrated prenatally by targeted scanning using appropriate technique. The method provided is feasible, reproducible, and has excellent performance indices. This novel technique and observations may improve the prenatal diagnosis and counseling of esophageal atresia.
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Affiliation(s)
- Tal Weissbach
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel.
| | - Anya Kushnir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Shayan Yousefi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Abeer Massarwa
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Leah Leibovitch
- Department of Neonatology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Denise-Dana Frank
- Department of Pathology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Debora Kidron
- Department of Pathology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Reuven Achiron
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Boaz Weisz
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Shali Mazaki Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Eran Kassif
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
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Friedrich L, Mor N, Weissmann‐Brenner A, Kassif E, Friedrich SN, Weissbach T, Castel E, Levin G, Meyer R. Risk factors for bladder injury during placenta accreta spectrum surgery. Int J Gynaecol Obstet 2022; 161:911-919. [PMID: 36353748 DOI: 10.1002/ijgo.14567] [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] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/23/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To identify risk factors associated with bladder injury during placenta accreta spectrum (PAS) surgeries. METHODS This retrospective cohort study was conducted at the Chaim Sheba Medical Center. The study population included pregnant women diagnosed with PAS undergoing uterine-preserving surgery or hysterectomy. Women with and without operative bladder injury were compared by univariate analysis followed by multivariate analysis. A sub-analysis of women without preoperative sonographic suspicion of bladder invasion was performed. RESULTS A total of 312 women were included in the study. Bladder injury incidence was 9.3% (n = 29). Uterine preservation was performed in 267/312 (85.6%) women. The number of previous cesarean deliveries and a preoperative sonogram suspicious for placenta percreta were found to be independent risk factors for intraoperative bladder injury (odds ratio [OR] 1.30, P = 0.019, and OR 5.23, P = 0.002, respectively). The number of previous cesarean deliveries and preoperative sonographic suspicion of placenta percreta were also associated with bladder injury in the sub-analysis (OR 1.30, P = 0.044 for previous cesarean deliveries, and OR 3.36, P = 0.036, for preoperative suspicion of bladder injury). CONCLUSION The number of previous cesarean deliveries and preoperative suspicion of placenta percreta are preoperative factors that can assist in preoperative planning and intraoperative management of PAS cases.
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Affiliation(s)
- Lior Friedrich
- The Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben‐Gurion University of the Negev
| | - Nizan Mor
- School of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Alina Weissmann‐Brenner
- School of Medicine Tel‐Aviv University Tel‐Aviv Israel
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center Ramat‐Gan Israel
| | - Eran Kassif
- School of Medicine Tel‐Aviv University Tel‐Aviv Israel
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center Ramat‐Gan Israel
| | | | - Tal Weissbach
- School of Medicine Tel‐Aviv University Tel‐Aviv Israel
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center Ramat‐Gan Israel
| | - Elias Castel
- School of Medicine Tel‐Aviv University Tel‐Aviv Israel
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center Ramat‐Gan Israel
| | - Gabriel Levin
- The Department of Gynecologic Oncology, Hadassah Medical Center Jerusalem Israel
- The Faculty of Medicine Hebrew University Jerusalem Israel
| | - Raanan Meyer
- School of Medicine Tel‐Aviv University Tel‐Aviv Israel
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center Ramat‐Gan Israel
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer Ramat‐Gan Israel
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Weissmann-Brenner A, Domniz N, Meyer R, Weissbach T, Elkan T, Salem Y, Bart Y, Kassif E, Weisz B. Delivery Outcome of Fetuses with Congenital Heart Disease-Is It Influenced by Prenatal Diagnosis? J Clin Med 2022; 11:jcm11144075. [PMID: 35887840 PMCID: PMC9319522 DOI: 10.3390/jcm11144075] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/12/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023] Open
Abstract
Objective: The objective of this study is to assess the delivery outcomes of neonates with congenital heart defects (CHD), and to explore the effect of prenatal diagnosis on these outcomes. Methods: A retrospective study including singleton deliveries between 2011 and 2020. All singleton neonates delivered at >24 weeks of gestation were included in this study. Fetuses with known prenatal anomalies other than CHD were excluded from this study. Pregnancy and neonatal outcomes were analyzed. A comparison was made between pregnancies with CHD and controls; and between pregnancies with prenatal diagnosis of CHD and postnatal diagnosis of CHD. Results: A total of 1598 neonates with CHD (688, 43.1% diagnosed prenatally) comprised the study group, compared to 85,576 singleton controls. Pregnancies with CHD had significantly increased BMI before pregnancy, suffered more from diabetes and chronic hypertension, had more inductions of labor, and had more cesarean deliveries (CD) including both elective CD and urgent CD due to non-reassuring fetal monitor (NRFHR) (OR = 1.75; 95%CI 1.45−2.14). Prenatal diagnosis of CHD is associated with a significant increased rate of induction of labor compared to postnatal diagnosis of CHD (OR = 1.59; 95% CI 1.15−2.22), but did not affect the mode of delivery including the rate of CD and CD due to non-reassuring fetal heart rate (NRFHR). Gestational age at birth and birthweight were significantly lower in pregnancies with CHD compared to controls, with no difference between prenatal to postnatal diagnosis of the anomaly. Neonates with CHD had a higher incidence of hypoxic ischemic encephalopathy and seizures compared to controls without any impact by prenatal diagnosis. Conclusion: Prenatal diagnosis of CHD is associated with an increased rate of induction of labor, with no increased rate of CD and CD due to NRFHR. The 5-min Apgar score is lower in pregnancies with postnatal diagnosis of CHD.
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Affiliation(s)
- Alina Weissmann-Brenner
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Correspondence: ; Tel.: +972-3-530-8116; Fax: +972-3-530-3168
| | - Noam Domniz
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Raanan Meyer
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Tal Weissbach
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Tal Elkan
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Yishai Salem
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Pediatric Cardiology Unit, Department of Pediatrics, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel
| | - Yossi Bart
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Eran Kassif
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Boaz Weisz
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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Weissmann-Brenner A, Domniz N, Weissbach T, Mazaki-Tovi S, Achiron R, Weisz B, Kassif E. Antenatal Detection of True Knot in the Umbilical Cord - How Accurate Can We Be? Ultraschall Med 2022; 43:298-303. [PMID: 32674187 DOI: 10.1055/a-1205-0411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Umbilical cord knot (UCK) is associated with increased risk of fetal death, but is usually diagnosed only after delivery. Our objective was to examine the accuracy of prenatal ultrasound in the diagnosis of UCK and the outcomes of these pregnancies. METHODS A prospective study was performed on 56 patients in which UCK was suspected during a routine level-II anatomical scan (study group). Data included demographics, pregnancy outcome, and short-term neonatal follow-up. The control group included pregnant women with normal pregnancy without UCK in a 4:1 ratio matched for gestational age at delivery. RESULTS True knot was observed postnatally in 54 out of 56 fetuses (detection rate of 96.4 %). Gestational age at diagnosis of UCK was 22.1 ± 3.1 weeks. The female to male ratio was 1:1 in both groups. Maternal age and parity were significantly higher in pregnancies with UCK compared to controls. The mean gestational age at delivery was 37.1 weeks of gestation in the UCK group. There was no difference in the birthweight percentile. 47 patients (87 %) underwent induction of labor. There were no differences in the rate of cesarean section or Apgar scores. No neonate with UCK needed ventilation. None suffered from seizures and none needed brain imaging. There were no cases of fetal or neonatal death in the pregnancies with UCK. CONCLUSION There is a high detection rate of UCK during targeted scan of the umbilical cord performed during the level-II anatomical scan. Careful pregnancy follow-up and early term delivery may result in excellent obstetrical outcomes.
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Affiliation(s)
- Alina Weissmann-Brenner
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Domniz
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shalev Mazaki-Tovi
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuven Achiron
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weissbach T, Sharon R, Mazaki Tovi S, Weisz B, Kassif E. Fetal Wormian bones: a curious congenital finding. Am J Obstet Gynecol 2022; 226:415-416. [PMID: 34537160 DOI: 10.1016/j.ajog.2021.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/09/2021] [Indexed: 11/01/2022]
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20
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Weissbach T, Kushnir A, Haber Kaptsenel E, Leibovitch L, Bilik R, Shinhar D, Karplus G, Achiron R, Kivilevitch Z, Barzilay E, Mazaki Tovi S, Weisz B, Kassif E. Oesophageal atresia: sonographic signs may prenatally predict surgical complexity. Arch Dis Child Fetal Neonatal Ed 2022; 107:206-210. [PMID: 34321245 DOI: 10.1136/archdischild-2021-321836] [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: 02/11/2021] [Accepted: 07/09/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Oesophageal atresia (OA) is a major anomaly of varying severity. The complexity of surgical correction highly depends on the gap length of missing oesophagus and the presence of a distal fistula. The aim of this study was to identify antenatal sonographic findings associated with presence of a distal fistula and type of surgical repair METHODS: Prenatal medical records of neonates postnatally diagnosed with OA were reviewed. Sonographic signs of OA (small/absent stomach, polyhydramnios, oesophageal pouch) and the trimester at sign detection were recorded and compared between (1) OA with and without a distal fistula and (2) early one-step versus delayed two-step anastomosis. Multivariate analysis was performed. RESULTS Overall, 80 cases of OA were included. Absence of a distal fistula was significantly associated with higher rates of small/absent stomach (100% vs 28.6%, P<0.0001), oesophageal pouch (100% vs 24.3%, P<0.0001) and severe polyhydramnios (66.7% vs 22.9%, P=0.006), compared with OA with a distal fistula.Cases requiring a delayed two-step repair had higher rates of small/absent stomach (84.2% vs 16.7%, P>0.0001), severe polyhydramnios (47.4% vs 16.7%, P=0.008) and oesophageal pouch (73.7% vs 18.5%, P<0.0001), compared with those corrected in an early one-step anastomosis.Multivariate logistic regression found small/absent stomach and pouch to be significantly and independently associated with a delayed two-step anastomosis. CONCLUSION OA without a distal fistula is associated with higher rates of prenatal sonographic signs. Both small/absent stomach and a pouch are independently associated with a delayed two-step anastomosis. These findings may help improve antenatal parental counselling regarding the anticipated surgical repair.
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Affiliation(s)
- Tal Weissbach
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel .,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Anya Kushnir
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Leah Leibovitch
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Neonatology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Ron Bilik
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Pediatric Surgery, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Daniel Shinhar
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Pediatric Surgery, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Gideon Karplus
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Pediatric Surgery, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Reuven Achiron
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Zvi Kivilevitch
- Women's Ultrasound Unit, Maccabi Health Services, Beer Sheva, Israel
| | - Eran Barzilay
- Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Shali Mazaki Tovi
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Boaz Weisz
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Eran Kassif
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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21
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Steg Saban O, Weissbach T, Achiron R, Pekar Zlotin M, Haberman Y, Kassif E, Weiss B. A221 CONGENITAL PORTOSYSTEMIC SHUNTS: FROM PRENATAL DIAGNOSIS TO LONG- TERM POSTNATAL OUTCOME. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859223 DOI: 10.1093/jcag/gwab049.220] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Congenital portosystemic shunts (CPSS) are rare vascular malformations that result in blood bypassing the liver and re-entering the systemic circulation unfiltered. The outcomes of CPSS diagnosed prenatally are unknown. Previously published data is related to patients diagnosed after symptom appearance, including hepatic encephalopathy, liver tumors and portal hypertension.
Aims
To describe a cohort of prenatally diagnosed children with CPSS and report on the natural history and outcomes.
Methods
The study was conducted between 2006 and 2019. Prenatal diagnosis was performed during routine prenatal ultrasound. Patients were followed by the pediatric gastroenterologists’ unit.
Results
32 patients were identified; 28 patients with intrahepatic shunts and four patients with extrahepatic shunts. During follow up, Failure to Thrive (FTT) was observed in three of the patients with one shunt (16.7%), and five of the patients with two shunts or more (55.6%). The difference is significant (p- value=0.037). 24 patients with intrahepatic shunts had their shunts closed spontaneously. Median time for closure of the shunt was seven months (IQR 2–14 months, range 0–35 months). No predicting factor was detected for closure of the shunt before the age of one year. All extrahepatic shunts required surgical closure.
Conclusions
Congenital intrahepatic shunts usually close spontaneously and do not need intervention. All patients in our prenatally diagnosed cohort survived with limited to no sequelae.
Funding Agencies
None
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Affiliation(s)
- O Steg Saban
- The Hospital for Sick Children, Toronto, ON, Canada
| | - T Weissbach
- Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - R Achiron
- Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | | | - Y Haberman
- Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - E Kassif
- Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - B Weiss
- Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
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22
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Kassif E, Elkan Miller T, Tsur A, Trozky Y, Gur T, De Castro H, Hadi E, Yulzari V, Weissmann-Brenner A, Messing B, Yoeli-Ullman R, Sharon R, Mazaki-Tovi S, Achiron R, Weisz B, Weissbach T. Dynamic esophageal patency assessment: an effective method for prenatally diagnosing esophageal atresia. Am J Obstet Gynecol 2021; 225:674.e1-674.e12. [PMID: 34146530 DOI: 10.1016/j.ajog.2021.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Esophageal atresia is a major anomaly with a low prenatal detection rate. We propose a sonographic method termed dynamic esophageal patency assessment. OBJECTIVE This study aimed to assess the feasibility and performance of the dynamic esophageal patency assessment in a high-risk population. STUDY DESIGN A prospective study was conducted in a single tertiary fetal ultrasound unit for 12 months. The study group included pregnant women referred for a targeted scan because of one or more of the following: (1) polyhydramnios; (2) small or absent stomach; (3) vertebral, anal atresia, cardiac, tracheoesophageal fistula, renal, and limb abnormalities; (4) first-degree relative with esophageal atresia; and (5) genetic mutation associated with esophageal atresia. In addition to dynamic esophageal patency assessment, a comprehensive anomaly scan was carried out. The fetal esophagus was observed during swallowing. Cases that demonstrated uninterrupted fluid propagation through the esophagus were classified as normal. Cases that demonstrated interrupted fluid propagation, with the formation of a pouch, were classified as abnormal. Cases with unclear visualization of the esophagus or cases that failed to demonstrate either fluid propagation or a pouch were classified as undetermined. Dynamic esophageal patency assessment results were compared with postnatal findings, considered "gold standard." Test performance indices and intra- and interobserver agreements were calculated. RESULTS For 12 months, 130 patients were recruited, and 132 fetuses were scanned. The median gestational age (interquartile range) at the time of scan was 31.4 weeks (29.0-35.3). Of 132 fetuses enrolled, 123 (93.2%) were normal, 8 (6%) were abnormal, and 1 (0.8%) was undetermined. Excluded from test performance analysis were 3 cases that were terminated without postmortem autopsy (1 was abnormal and 2 were normal), and a fourth case was excluded as it was classified as undetermined. The detection rate of esophageal atresia was 100%, with no false-positive or false-negative case. Sensitivity, specificity, and positive and negative predictive values of the dynamic esophageal patency assessment were 100%. The Kappa coefficient was 1 for both inter- and intraobserver agreements (P<.0001). The median time (interquartile range) required to complete the dynamic esophageal patency assessment was 6.00 minutes (3.00-13.25). CONCLUSION The dynamic esophageal patency assessment is a feasible and highly effective method of ascertaining an intact esophagus and detecting esophageal atresia in suspected cases.
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23
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Schreiber H, Toledano H, Weissbach T, Kassif E, Tsur A, Biron-Shental T, Weisz B. Growth Velocity and Doppler Evaluation to Predict Nonreassuring Fetal Heart Rate at Birth in Low-Risk Women: A Prospective, Longitudinal Study. Fetal Diagn Ther 2021; 48:624-632. [PMID: 34515109 DOI: 10.1159/000517519] [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: 11/15/2020] [Accepted: 05/31/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study investigated whether fetal growth deceleration in term, appropriate-for-gestational-age (AGA) fetuses is associated with placental insufficiency and nonreassuring fetal heart rate (NRFHR) at birth. METHODS In this prospective study, 246 low-risk, singleton pregnancies at term with AGA fetuses were recruited. Correlation between decreased growth velocity (decline in estimated fetal weight [EFW] percentile), low EFW (EFWQ1 = latest EFW between 11 and 25% percentiles), umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, and cerebro-placental ratio (CPR) with cesarean and instrumental deliveries due to NRFHR were tested. RESULTS The median change between fetal weight estimates (percentiles/week) was +0.49% (95% CI: -4 to +5%). Ten percent had decreased EFW percentile >3.5%/week. Fetal growth velocity/week was associated with MCA (r = 0.21, p < 0.001) and CPR (r = 0.24, p < 0.001) and inversely correlated with UA PI (r = -0.28, p < 0.001). NRFHR and cesarean section (CS) rates due to NRFHR were associated with decreased growth velocity, EFWQ1, and low CPR. The combination of abnormal CPR with decreased growth velocity occurred in 12 pregnancies, of which 5 (42%) had urgent CS due to NRFHR. The combination of abnormal CPR with EFWQ1 occurred in 9 pregnancies, of which 4 (44%) had urgent CS due to NRFHR. These combinations increased the likelihood ratio of CS due to NRFHR two-fold (8.41; 2.54-24.5) but did not significantly alter the number needed to treat by elective CS (3.78-4.68). CONCLUSION Fetal growth velocity, EFW between 10 and 25th percentiles (EFWQ1), and abnormal CPR improves prediction of unplanned CS due to NRFHR among term AGA fetuses. This should be considered when counseling about the delivery method.
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Affiliation(s)
- Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hen Toledano
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Tal Weissbach
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Eran Kassif
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Abraham Tsur
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
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Zajicek M, Kassif E, Weisz B, Berkovitz Shperling R, Lipitz S, Weissbach T, Barzilay E, Orvieto R, Haas J. "One-stop shop" for the evaluation of the infertile patient: hystero-salpingo foam sonography combined with two and three dimensional ultrasound and sonohysterography. J OBSTET GYNAECOL 2021; 42:670-674. [PMID: 34448669 DOI: 10.1080/01443615.2021.1929113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hysterosalpingo-foam sonography (HyFoSy) is considered an acceptable alternative for hysterosalpingography (HSG). By combining HyFoSy with two and three-dimensional (2D and 3D) ultrasound and hysterosonography, a complete fertility work-up can be done. We aimed to evaluate the value of a combined ultrasound examination for fertility work-up. During the study period 113 women were examined. Five of 113 (4.4%) examinations were abandoned due to intra-uterine adhesions that were detected by hysterosonography, and five (4.4%) were abandoned due to technical difficulties. Of 103 women who had completed the examination, 2D ultrasound revealed six patients with hydrosalpinx (5.8%) and sonographic signs of adenomyosis in 13 (12.6%) patients. By combining 2D ultrasound with hysterosonography, two (1.9%) fibroids that were penetrating the uterine cavity and seven (6.8%) endometrial polyps were detected. HyFoSy showed bilateral patent tubes in 58 patients (56.3%), unilateral tubal occlusion in 29 (28.1%) and bilateral tubal occlusion in 16 (15.5%). This study shows that the 'one-stop shop' examination is feasible. The combined examination had detected 16 pathological findings that would have not been detected by HyFoSy alone. Hence, it should be offered to couples undergoing routine infertility work-up.IMPACT STATEMENTWhat is already known on this subject? The accuracy of the HyFoSy alone has been evaluated in different studies, but this presented ultrasound scan is integrating 4 different modalities in one exam (2D scanning of the pelvis, 3D scanning of the uterus, hysterosonography and HyFoSy) and we were able to evaluate the female pelvic organs, including the uterine cavity, the tubes and the ovaries, in order to expand the range of diagnosed pathologies.What do the results of this study add? The concept of 'one-stop shop' for the evaluation of female pelvis in couples suffering from infertility is feasible, has comparable accuracy as HSG for tubal occlusion, and higher detection rate for uterine malformations.What are the implications of these findings for clinical practice and/or further research? We suggest to incorporate this examination in routine fertility work-up.
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Affiliation(s)
- Michal Zajicek
- Institute of Obstetrics and Gynecological Imaging and Fetal therapy, Department of Obstetrics and Gynecology, affiliated with the Sackler School of Medicine Tel Aviv University, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Eran Kassif
- Institute of Obstetrics and Gynecological Imaging and Fetal therapy, Department of Obstetrics and Gynecology, affiliated with the Sackler School of Medicine Tel Aviv University, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Boaz Weisz
- Institute of Obstetrics and Gynecological Imaging and Fetal therapy, Department of Obstetrics and Gynecology, affiliated with the Sackler School of Medicine Tel Aviv University, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Raz Berkovitz Shperling
- Institute of Obstetrics and Gynecological Imaging and Fetal therapy, Department of Obstetrics and Gynecology, affiliated with the Sackler School of Medicine Tel Aviv University, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Shlomo Lipitz
- Institute of Obstetrics and Gynecological Imaging and Fetal therapy, Department of Obstetrics and Gynecology, affiliated with the Sackler School of Medicine Tel Aviv University, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Tal Weissbach
- Institute of Obstetrics and Gynecological Imaging and Fetal therapy, Department of Obstetrics and Gynecology, affiliated with the Sackler School of Medicine Tel Aviv University, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod Hospital, Ashdod, Israel, affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Raoul Orvieto
- IVF Unit, Department of Obstetrics and Gynecology, affiliated with the Sackler School of Medicine Tel Aviv University, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Jigal Haas
- IVF Unit, Department of Obstetrics and Gynecology, affiliated with the Sackler School of Medicine Tel Aviv University, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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25
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Weissmann-Brenner A, Meyer R, Domniz N, Levin G, Hendin N, Yoeli-Ullman R, Mazaki-Tovi S, Weissbach T, Kassif E. The perils of true knot of the umbilical cord: antepartum, intrapartum and postpartum complications and clinical implications. Arch Gynecol Obstet 2021; 305:573-579. [PMID: 34405285 DOI: 10.1007/s00404-021-06168-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/31/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND True knot of the umbilical cord (TKUC) is found in 0.3-2.1% of pregnancies and is associated with an increased risk of adverse perinatal outcomes. METHODS A retrospective cohort study including all singleton pregnancies delivered from 2011 to 2019 was performed. Diagnosis of TKUC was made postnatally, immediately after delivery of the baby. Comparison was made between pregnancies with and without TKUC regarding maternal, fetal and neonatal adverse outcome. RESULTS Overall, 867/85,541 (1%) pregnancies were diagnosed with TKUC. Maternal age, BMI, gravidity and parity were significantly higher in pregnancies with TKUC as well as higher rate of induction of labor, meconium-stained amniotic fluid, and delivery prior to 37 weeks. The rate of cesarean deliveries due to non-reassuring-fetal monitor was significantly higher in pregnancies with TKUC. Overall, there were 2.5% IUFD in pregnancies with TKUC vs. 1% in pregnancies without TKUC (p < 0.001). Importantly, the rate of IUFD prior to 37 weeks of gestation was not significantly higher in the group with TKUC, however, the rate of IUFD after 37 weeks of gestation was 10 folds higher in fetuses with TKUC, 0.9% vs. 0.08% (p < 0.001). Significantly, more neonates with TKUC needed phototherapy or suffered from hypoglycemia. There were no differences in the 5 min Apgar scores, admission to the NICU and number of days of hospitalization. CONCLUSION Pregnancies complicated with TKUC are associated with a tenfold higher risk of IUFD beyond 37 weeks of gestation. To the results of this study suggest that it would be prudent to induce labor around 37 weeks of gestation in pregnancies with prenatal diagnosis of TKUC. It may be warranted to use continuous fetal monitoring during labor and delivery in those cases were antenatal diagnosis of TKUC is made.
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Affiliation(s)
- Alina Weissmann-Brenner
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.
| | - Raanan Meyer
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Noam Domniz
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Levin
- The Department Gynecologic Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Natav Hendin
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Rakefet Yoeli-Ullman
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Shali Mazaki-Tovi
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
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26
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Kassif E, Weissbach T, Shust‐Barequet S, Raviv O, Snenh SA, Avraham E, Cahan T, Koren N, Yulzari V, Hadi E, Adamo L, Revivo M, Tovi SM, Achiron R, Kivilevitch Z, Weisz B, Weissmann‐Brenner A. The fetal stomach throughout gestation: Normal charts and clinical implication. Prenat Diagn 2021. [DOI: 10.1002/pd.5990] [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: 11/07/2022]
Affiliation(s)
- Eran Kassif
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Tal Weissbach
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Shir Shust‐Barequet
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Oshrat Raviv
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Obstetrics and Gynecology Meir Medical Center Kfar Saba Israel
| | - Samar Abu Snenh
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Efrat Avraham
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Obstetrics and Gynecology Meir Medical Center Kfar Saba Israel
| | - Tal Cahan
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Natalie Koren
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Obstetrics and Gynecology Meir Medical Center Kfar Saba Israel
| | - Vered Yulzari
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Efrat Hadi
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Laura Adamo
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Department of Obstetrics and Gynecology IRCCS Fondazione Policlinico San Matteo University of Pavia Pavia Italy
| | - Marva Revivo
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Shalev Mazaki Tovi
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Reuven Achiron
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Zvika Kivilevitch
- Women's Ultrasound Unit Maccabi Health Services Negev Medical Center Beer‐Sheva Israel
| | - Boaz Weisz
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Alina Weissmann‐Brenner
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
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Kassif E, Weissbach T, Kushnir A, Shust-Barequet S, Elkan-Miller T, Mazkereth R, Weissmann-Brenner A, Achiron R, Weisz B. Esophageal atresia and tracheoesophageal fistula: prenatal sonographic manifestation from early to late pregnancy. Ultrasound Obstet Gynecol 2021; 58:92-98. [PMID: 32304613 DOI: 10.1002/uog.22050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/17/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Esophageal atresia and/or tracheoesophageal fistula (EA/TEF) remains one of the most frequently missed congenital anomalies prenatally. The aim of our study was to elucidate the sonographic manifestation of EA/TEF throughout pregnancy. METHODS This was a retrospective study of data obtained from a tertiary center over a 12-year period. The prenatal ultrasound scans of fetuses with EA/TEF were assessed to determine the presence and timing of detection of three principal signs: small/absent stomach and worsening polyhydramnios, both of which were considered as 'suspected' EA/TEF, and esophageal pouch, which was considered as 'detected' EA/TEF. We assessed the yield of the early (14-16 weeks' gestation), routine mid-trimester (19-26 weeks) and third-trimester (≥ 27 weeks) anomaly scans in the prenatal diagnosis of EA/TEF. RESULTS Seventy-five cases of EA/TEF with available ultrasound images were included in the study. A small/absent stomach was detected on the early anomaly scan in 3.6% of fetuses scanned, without a definitive diagnosis. On the mid-trimester scan, 19.4% of scanned cases were suspected and 4.3% were detected. On the third-trimester anomaly scan, 43.9% of scanned cases were suspected and 33.9% were detected. An additional case with an esophageal pouch was detected on magnetic resonance imaging (MRI) in the mid-trimester and a further two were detected on MRI in the third trimester. In total, 44.0% of cases of EA/TEF in our cohort were suspected, 33.3% were detected and 10.7% were suspected but, eventually, not detected prenatally. CONCLUSIONS Prenatal diagnosis of EA/TEF on ultrasound is not feasible before the late second trimester. A small/absent stomach may be visualized as early as 15 weeks' gestation. Polyhydramnios does not develop before the mid-trimester. An esophageal pouch can be detected as early as 22 weeks on a targeted scan in suspected cases. The detection rates of all three signs increase with advancing pregnancy, peaking in the third trimester. The early and mid-trimester anomaly scans perform poorly as a screening and diagnostic test for EA/TEF. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Kassif
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Weissbach
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Kushnir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Shust-Barequet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Elkan-Miller
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Mazkereth
- Department of Neonatology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Weissmann-Brenner
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Achiron
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Elkan Miller T, Weisz B, Yinon Y, Weissbach T, De Castro H, Avnet H, Hoffman C, Katorza E, Lipitz S. Congenital Cytomegalovirus Infection Following Second and Third Trimester Maternal Infection Is Associated With Mild Childhood Adverse Outcome Not Predicted by Prenatal Imaging. J Pediatric Infect Dis Soc 2021; 10:562-568. [PMID: 33393625 DOI: 10.1093/jpids/piaa154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/24/2020] [Accepted: 11/29/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND While it is clear that first trimester congenital cytomegalovirus (CMV) infection can lead to serious neonatal and childhood adverse outcome, the extent of the effect of second and third trimester congenital CMV infection is still unclear. Our aim was to study the short- and long-term outcomes following second and third trimester infection and to evaluate the contribution of prenatal imaging in a prospective cohort. METHODS We studied pregnant women with primary CMV infection in the second and third trimesters, as diagnosed by well-dated seroconversion, and proof of vertical CMV transmission. All patients underwent serial prenatal ultrasound (US) and most of them fetal magnetic resonance imaging (MRI). Follow-up information was obtained from hospital charts and by telephone interviews with parents. RESULTS Primary CMV infection occurred in 135 patients, 107 and 28 with second and third trimester infection, respectively. The incidence proportion of composite outcome (hearing loss or neurodevelopmental impairment) following second trimester infection was 7% (7/100, after excluding cases that were terminated) with a 3% incidence of partial unilateral sensory neural hearing loss and a 5% incidence of minor neurodevelopmental abnormalities, including slight verbal and motor delay. Following third trimester infection, there was one case of a very mild motor delay. The incidence proportion of abnormal prenatal findings on US or MRI was not significantly correlated to hearing loss or neurodevelopmental abnormalities. CONCLUSIONS Second trimester infection is associated with a slight risk of developing mild childhood sequelae, mostly partial unilateral hearing loss, which may develop late in childhood. Prenatal imaging failed to predict the development of childhood adverse outcome.
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Affiliation(s)
- Tal Elkan Miller
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Boaz Weisz
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoaz Yinon
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Weissbach
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Hila De Castro
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Hagai Avnet
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Chen Hoffman
- Department of Radiology, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Eldad Katorza
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomo Lipitz
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
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Kassif E, Weissbach T, Raviv O, Shust-Barequet S, Koren N, Fishel Bartal M, Achiron R, Mazaki-Tovi S, Weisz B, Elkan Miller T. Fetal esophageal imaging: Early pregnancy as a window of opportunity. Prenat Diagn 2021; 41:861-867. [PMID: 33591583 DOI: 10.1002/pd.5920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the sonographic appearance of the fetal esophagus during early pregnancy and evaluate the feasibility of imaging the entire esophageal length. In addition, we present a case of disrupted esophageal continuity, subsequently diagnosed with esophageal atresia (EA). METHODS A prospective observational study of 145 patients. During the early second trimester anomaly scan performed at 12-17 weeks' gestation the entire esophagus was captured in a single sonographic image at the midsagittal plane (one shot technique). Postnatal follow-up of esophageal patency included review of medical records and telephone interviews. RESULTS Complete visualization of the esophagus (neck to diaphragm) was possible in 144 cases. In 88% of cases the esophagus was demonstrated by transvaginal approach. The time required to obtain the desired view of the esophagus, once the fetus was in an optimal position, was on average 13 s (range: 5-30 s). In one case at 15 weeks' gestation, the cervical segment of the esophagus was demonstrated while the lower thoracic segment was not identified. Subsequently EA was diagnosed. CONCLUSIONS It is feasible to demonstrate the entire esophagus during early second trimester anomaly scan. An early second trimester anomaly scan may serve as a window of opportunity for EA screening.
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Affiliation(s)
- Eran Kassif
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Weissbach
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oshrat Raviv
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shir Shust-Barequet
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Natalie Koren
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Fishel Bartal
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reuven Achiron
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shali Mazaki-Tovi
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Boaz Weisz
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Elkan Miller
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Segev M, Weissmann-Brenner A, Weissbach T, Kassif E, Weisz B. Intra-observer variability of Doppler measurements in umbilical artery (UA) and middle cerebral artery (MCA) in uncomplicated term pregnancies. J Matern Fetal Neonatal Med 2021; 35:5653-5658. [PMID: 33715569 DOI: 10.1080/14767058.2021.1888920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the intra-observer variability of the middle cerebral artery (MCA) and umbilical artery (UA) Doppler measurement taken under optimal conditions in term, uncomplicated pregnancies. METHODS A prospective study on uncomplicated singleton term pregnancies was performed. Multiple Doppler measurements were taken in the MCA and the UA by one examiner. Intra-rater agreement was calculated. Doppler indices were correlated to fetal biometric parameters and to gestational age. RESULTS One hundred patients were recruited. MCA indices were found to have the highest strength of intra-rater/observer agreement (K = 0.888) versus only a "good" agreement for UA pulsatility index (PI) (K = 0.755).The MCA-PI was significantly correlated with BPD (r = -0.198, p = .047), EFW (r = -0.241, p = .01) and birthweight (r = -0.208, p = .03). A statistically significant decrease was found in the MCA PI (r = -.422, p < .001) and in the CPR (r = -0.444, p < .001) with advancing pregnancy, between 37 and 42 weeks gestation. The UA PI did not change significantly (p = .099) during this period. CONCLUSIONS MCA PI measured at term is reproducible with a high ICC. MCA PI significantly decreases with advancing gestation at term. No correlation was found between Doppler measurements and time to delivery.
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Affiliation(s)
- Meirav Segev
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alina Weissmann-Brenner
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lipitz S, Elkan Miller T, Yinon Y, Weissbach T, De-Castro H, Hoffman C, Katorza E, Weisz B. Revisiting short- and long-term outcome after fetal first-trimester primary cytomegalovirus infection in relation to prenatal imaging findings. Ultrasound Obstet Gynecol 2020; 56:572-578. [PMID: 31858642 DOI: 10.1002/uog.21946] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/30/2019] [Accepted: 12/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine the short- and long-term outcome of pregnancies with proven first-trimester fetal cytomegalovirus (CMV) infection in a large prospective cohort. METHODS This was a prospective cohort study of pregnancies with documented primary maternal CMV infection in the first trimester and evidence of fetal infection, referred for further evaluation between January 2011 and January 2018. Maternal serological diagnosis of primary CMV infection was documented by seroconversion. Vertical CMV transmission was identified by amniocentesis with polymerase chain reaction (PCR) for the CMV genome. After birth, fetal infection was re-tested by PCR in neonatal urine or saliva samples. All patients underwent serial prenatal ultrasound scans and fetal magnetic resonance imaging (MRI) at 32-33 weeks' gestation. All neonates underwent ocular fundus examination, an ultrasound brain scan and hearing evaluation, and were followed periodically for a median of 2 years (range, 6 months to 10 years). Follow-up information was obtained from hospital charts and by telephone interviews with parents. The CMV-associated outcomes assessed were sensorineural hearing loss (SNHL), neurodevelopmental abnormality, composite clinical outcome (including SNHL and neurodevelopmental abnormality) and composite outcome (additionally including termination of pregnancy (TOP)). The association between prenatal ultrasound or MRI findings and abnormal outcome was assessed. RESULTS Primary CMV infection in the first trimester occurred in 123 patients. The rate of an abnormal ultrasound finding was 30.9%, and the rate of an abnormal MRI finding was 30.1% overall and 14.1% in the subgroup of patients with normal ultrasound. Of the 85 patients with normal ultrasound, 12 had an abnormal MRI finding, of whom five (5.9%) had true anatomical findings. Fifteen patients decided to terminate the pregnancy owing to abnormal prenatal findings on either ultrasound or MRI. Overall, the rate of CMV-associated postnatal and childhood sequelae was 27.8%, with a rate of 16.7% for SNHL and 11.1% for neurodevelopmental abnormalities, mostly slight motor or verbal delay. Approximately half of the cases with CMV-associated sequelae did not have any abnormal prenatal imaging findings. Abnormal prenatal findings on ultrasound were not associated significantly with SNHL, neurodevelopmental delay or composite clinical outcome (P = 0.084, 0.109 and 0.176, respectively), but they were associated with the composite outcome including TOP (P < 0.001). We identified a non-significant trend for a higher rate of SNHL in the group with abnormal ultrasound than in those with normal ultrasound. For abnormal MRI findings, we found a correlation only with neurodevelopmental abnormality and composite outcome (P = 0.014 and P < 0.001, respectively). CONCLUSIONS The risk of childhood sequelae after first-trimester fetal CMV infection is most often associated with abnormal prenatal imaging findings. However, normal imaging does not rule out the development of SNHL and minor neurodevelopmental abnormalities. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Lipitz
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - T Elkan Miller
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Y Yinon
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - T Weissbach
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - H De-Castro
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - C Hoffman
- Department of Radiology, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - E Katorza
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - B Weisz
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
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Lipitz S, Miller TE, Yinon Y, Weissbach T, De-Castro H, Hoffman C, Katorza E, Weisz B. Reply. Ultrasound Obstet Gynecol 2020; 56:632-633. [PMID: 33001495 DOI: 10.1002/uog.23106] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- S Lipitz
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - T Elkan Miller
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Y Yinon
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - T Weissbach
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - H De-Castro
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - C Hoffman
- Department of Radiology, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - E Katorza
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - B Weisz
- Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel
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Kassif E, Tsur A, Shust-Barequet S, Raviv O, Kushnir A, Abu Snenh S, Achiron R, Mazaki-Tovi S, Weisz B, Salem Y, Weissbach T. The “No ARSA” Sign: A Novel Method of Prenatal Screening for Aberrant Right Subclavian Artery. J Clin Med 2020; 9:jcm9082658. [PMID: 32824459 PMCID: PMC7463697 DOI: 10.3390/jcm9082658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022] Open
Abstract
An aberrant right subclavian artery (ARSA) can be overlooked by the conventional method as described by Chaoui et al., due to acoustic shadowing. The aim of this study was to evaluate the feasibility and accuracy of a novel screening method for ARSA by demonstrating the brachiocephalic artery bifurcation, referred to as the “No ARSA” sign. A prospective study conducted at a tertiary care center between 2018 and 2019 included unselected pregnant patients at a median gestational age of 15.1 (14.2–22.1; IQR (inter-quartile range)) weeks, who had been referred for a routine or targeted anomaly scan. All participants were scanned for the presence or absence of ARSA using both the conventional and the novel “No ARSA” methods for validation purposes. A total of 226 unselected patients were enrolled in the study. The “No ARSA” sign was visualized in 218 fetuses (96.5%). In the remaining 8 cases (3.5%), the “No ARSA” sign was not demonstrated. In these fetuses, an ARSA was visualized by the conventional method. The new method exhibited 100% feasibility and was in complete agreement with the conventional method. Intra- and inter-observer agreement was excellent (κ = 1). The results of the study suggest that the “No ARSA” sign is an efficient and reliable screening tool for ARSA.
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Affiliation(s)
- Eran Kassif
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Abraham Tsur
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Shir Shust-Barequet
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Oshrat Raviv
- Departments of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Anya Kushnir
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Samar Abu Snenh
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Reuven Achiron
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Shali Mazaki-Tovi
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Boaz Weisz
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Yishay Salem
- Pediatric Cardiology Unit, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: (Y.S.); (T.W.); Tel.: +972-546-250-299 (T.W.)
| | - Tal Weissbach
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
- Correspondence: (Y.S.); (T.W.); Tel.: +972-546-250-299 (T.W.)
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Weissbach T, Kassif E, Kushnir A, Shust‐Barequet S, Leibovitch L, Eliasi E, Elkan‐Miller T, Zajicek M, Yinon Y, Weisz B. Esophageal atresia in twins compared to singletons: In utero manifestation and characteristics. Prenat Diagn 2020; 40:1418-1425. [DOI: 10.1002/pd.5785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Tal Weissbach
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Anya Kushnir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Shir Shust‐Barequet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Leah Leibovitch
- Department of Neonatology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Elior Eliasi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Tal Elkan‐Miller
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Michal Zajicek
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Yoav Yinon
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
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Weissbach T, Kushnir A, Rasslan R, Rosenblatt O, Yinon Y, Berkenstadt M, Weisz B, Mazaki Tovi S, Kassif E. Fetal pleural effusion: Contemporary methods of genetic evaluation. Prenat Diagn 2019; 39:751-757. [PMID: 31169934 DOI: 10.1002/pd.5497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the contribution of chromosomal microarray (CMA) and other advanced genetic tests to the genetic evaluation of fetal pleural effusion (FPE) and to identify parameters that might assist in predicting genetic abnormality. METHODS A retrospective study of FPE cases referred between 2013 and 2018 was conducted. Cases that underwent genetic evaluation were divided into two groups, chromosomally normal and genetically abnormal. The types and prevalence of genetic abnormalities were reported. Clinical and sonographic parameters were compared. Univariate and multivariate analyses were performed to determine an association between different parameters and genetic abnormality. RESULTS Sixty-two cases were included in the study. Forty-eight cases were genetically assessed (karyotype, CMA, whole exome sequencing, Noonan panel, or a combination). A clinically significant genetic abnormality was detected in 29.17% (14/48) of cases. Aneuploidy and single gene disorders were found in 78.6% (11/14) and 21.4% (3/14) of abnormal cases. Four additional cases had microdeletion/duplications detected, yet none were of clinical significance. Multivariate analysis indicated that the presence of anomalies was statistically associated with genetic abnormality (95% CI, 1.144-168.2; 0.039). CONCLUSION In our cohort, CMA did not demonstrate an additional clinical yield over karyotyping. The presence of anomalies was independently associated with underlying genetic abnormality.
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Affiliation(s)
- Tal Weissbach
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anya Kushnir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rana Rasslan
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orgad Rosenblatt
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Yinon
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Berkenstadt
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shali Mazaki Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weissbach T, Hag-Yahia N, Ovadia M, Tzadikevitch Geffen K, Weitzner O, Biron-Shental T. Kiwi omnicup handheld versus Mityvac M-style conventional vacuum system: a retrospective observational study. J Matern Fetal Neonatal Med 2018; 31:3178-3182. [PMID: 28793827 DOI: 10.1080/14767058.2017.1366443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To improve the choice of vacuum-assisted delivery (VAD) system, we compared the outcomes of Kiwi handheld system and Mityvac M-style conventional system (both use disposable plastic cups). MATERIALS AND METHODS Retrospective observational study with data collection from electronic medical records. The study was conducted at a tertiary medical center, with approximately 7000 deliveries annually. Categorical and continuous variables were analyzed using chi-square test and t-test, respectively. p value < .05 was considered significant. The main outcomes assessed were the overall failure rate of each system, failure rates for occipito-anterior (OA) versus occipito-transverse/occipito-anterior (OT/OP) positions, +1 versus +2 fetal stations, and early maternal/neonatal outcomes. RESULTS During a 10-month period, there were 507 (8.4%) attempted VADs, 36 failed (7.1%), and eight (1.5%) converted to cesarean section. Of these, 364 were Kiwi-assisted and 143 Mityvac-assisted. Background characteristics were similar. The handheld system had more failures overall (9.6 versus 0.7%), at OA (7.6 versus 0.9%), and non-OA positions (17.3% versus none), at +1 (13.25 versus 0.96%) and at +2/3 stations (6.1% versus none), than the conventional system did, respectively. There was a higher rate of early post-partum hemorrhage (15.3 versus 7.4%) in the conventional group. Both systems had similar rates of third/fourth degree perineal tears, shoulder dystocia and adverse neonatal outcomes. CONCLUSIONS Our results suggest more failures with Kiwi compared to Mityvac, overall and at any fetal position/station, without a significant difference in adverse outcome profile.
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Affiliation(s)
- Tal Weissbach
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Nasreen Hag-Yahia
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Michal Ovadia
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Keren Tzadikevitch Geffen
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Omer Weitzner
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Tal Biron-Shental
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Weitzner O, Yagur Y, Weissbach T, Man El G, Biron-Shental T. Preeclampsia: risk factors and neonatal outcomes associated with early- versus late-onset diseases. J Matern Fetal Neonatal Med 2018; 33:780-784. [PMID: 30001660 DOI: 10.1080/14767058.2018.1500551] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: This study examined the effects of early-onset preeclampsia (EOPE) and late-onset preeclampsia (LOPE) on short-term maternal and neonatal morbidity, as well as risk factors associated with early-onset and late-onset diseases.Method: This retrospective, cohort study included pregnant women who had been diagnosed with PE during pregnancy. Electronic medical records were reviewed for demographics and medical history, laboratory tests, and delivery data. The women were grouped according to EOPE (<34 weeks) and LOPE (≥34 weeks). Power analysis revealed that a sample size of 35 was sufficient for each PE group, under the assumptions of type I error (two-sided) of 5% and at least 80% power to detect a 30% difference in composite outcomes between EOPE and LOPE.Results: Among 101 patients, 35 (34.7%) had EOPE and 66 (65.3%) developed LOPE. Alpha fetoprotein (AFP) and unconjugated estriol (UE3) were higher in the early-onset group (p = .015 and p= .002, respectively) and might be predictors of EOPE. There was a positive correlation between gestational age at PE diagnosis and gestational age at delivery. Patients with EOPE delivered earlier than patients with LOPE did (p<.0001).Conclusions: Patients who developed EOPE had higher of AFP and UE3 values at their second trimester biochemical screening. These parameters might be predictors of EOPE. We found a positive correlation between early gestational age at PE diagnosis and preterm delivery.
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Affiliation(s)
- Omer Weitzner
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Yagur
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Man El
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weissbach T, Heusler I, Ovadia M, David L, Daykan Y, Schreiber F, Biron-Shental T. The temporal effect of Category II fetal monitoring on neonatal outcomes. Eur J Obstet Gynecol Reprod Biol 2018; 229:8-14. [PMID: 30096466 DOI: 10.1016/j.ejogrb.2018.07.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To correlate the duration of Category II cardiotocograms (CTG) with adverse neonatal outcomes associated with perinatal asphyxia and determine the duration before fetal compromise. STUDY DESIGN This retrospective, observational study used electronic medical record data from a cohort of 271 patients, delivered by C-section due to non-reassuring fetal heart rate, at a tertiary medical center, from 2015 through 2017. Duration of Category II CTG, variability, tachycardia and deceleration frequency were analyzed and correlated to immediate postnatal outcomes. including cord pH ≤ 7, cord base excess >12, 1- and 5-min Apgar scores ≤7, need for ventilation, need for chest compressions, NICU admission, hypoglycemia and convulsions. Intrapartum fever and meconium stained amniotic fluid were correlated to the same outcomes. Categorical and continuous variables were analyzed using chi-square and t-tests, respectively. P < 0.05 was considered significant. RESULTS The mean duration of Category II CTG was 146 min (range 17-553). Longer duration did not result in increased rates of adverse neonatal outcomes. In contrast, reduced fetal heart rate (FHR) variability, fetal tachycardia and intrapartum fever did show increased rates of adverse neonatal outcomes, as follows: patients exhibiting reduced vs. normal (FHR) variability had 12.9% vs. 1.4% cord pH ≤ 7, P = 0.006 and 12.5% vs. 1.3% cord BE > 12, P = 0.004: patients with fetal tachycardia vs. normal baseline FHR exhibited 48% vs. 17.9% 1-minute Apgar score ≤7, P = 0.0004; 8% vs. 0.8% 5-minute Apgar score ≤7, P = 0.04; and 48% vs. 18.7% ventilation support, P < 0.001; patients with intrapartum fever vs. normal temperature, cord BE > 12 was seen in 9.7% vs. 1.7%, P = 0.035; 1-minute Apgar score was ≤7 in 35.5% vs. 18.7%, P = 0.03; 5-minute Apgar score ≤7 in 9.7% vs. 0.4%, P = 0.005; need for ventilation in 35.5% vs. 19.6%, P = 0.042; need for chest compressions in 6.45% vs. none, P = 0.013; and NICU admission in 12.9% vs. 2.5%, P = 0.018. CONCLUSIONS Our results suggest that the duration of Category II CTG alone does not appear to predict perinatal asphyxia. Parameters associated with perinatal asphyxia are reduced FHR variability, fetal tachycardia and intrapartum fever. Therefore, when contemplating intervention during labor to avoid fetal asphyxia, these parameters should be strongly considered.
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Affiliation(s)
- Tal Weissbach
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1).
| | - Ishai Heusler
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1)
| | - Michal Ovadia
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1)
| | - Liron David
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1)
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1)
| | - Faye Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1)
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1)
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Spencer R, Sebire N, Weissbach T, Krishnan T, Hutchinson C, David A. Maternal serum concentrations of soluble endoglin and soluble Vascular Endothelial Growth Factor Receptor 2 may predict the severity of villous hypoplasia in severe early-onset fetal growth restriction. Placenta 2017. [DOI: 10.1016/j.placenta.2017.07.203] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Weissbach T, Hag-Yahia N, Ovadia M, Tzadikevitch Geffen K, Weitzner O, Biron-Shental T. Kiwi OmniCup Handheld vs. Mityvac M-Style Conventional Vacuum System: A Retrospective Observational Study. J Matern Fetal Neonatal Med 2017:1-8. [PMID: 28818007 DOI: 10.1080/14767058.2017.1368484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To improve choice of vacuum-assisted delivery (VAD) system, we compared outcomes of Kiwi handheld system and Mityvac M-style conventional system (both use disposable plastic cups). MATERIALS AND METHODS Retrospective observational study with data collection from electronic medical records. The study was conducted at a tertiary medical center, with approximately 7000 deliveries annually. Categorical and continuous variables were analyzed using chi-square test and t-test, respectively. p value < 0.05 considered significant. The main outcomes assessed were the overall failure rate of each system, failure rates for occipito-anterior (OA) vs. occipito-transverse/occipito-anterior (OT/OP) positions, +1 vs. +2 fetal stations, and early maternal/neonatal outcomes. RESULTS During a 10-month period, there were 507 (8.4%) attempted VADs, 36 failed (7.1%) and 8 (1.5%) converted to cesarean section. Of these, 364 were Kiwi-assisted and 143 Mityvac-assisted. Background characteristics were similar. The handheld system had more failures overall (9.6 vs. 0.7%), at OA (7.6 vs. 0.9%) and non-OA positions (17.3% vs. none), at + 1 (13.25 vs. 0.96%) and at + 2/3 stations (6.1% vs. none), than the conventional system did, respectively. There was a higher rate of early post-partum hemorrhage (15.3 vs. 7.4%) in the conventional group. Both systems had similar rates of third/fourth degree perineal tears, shoulder dystocia and adverse neonatal outcomes. CONCLUSIONS Our results suggest more failures with Kiwi compared to Mityvac, overall and at any fetal position/station, without a significant difference in adverse outcome profile.
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Affiliation(s)
- Tal Weissbach
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel affiliated with Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Nasreen Hag-Yahia
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel affiliated with Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Michal Ovadia
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel affiliated with Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Keren Tzadikevitch Geffen
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel affiliated with Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Omer Weitzner
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel affiliated with Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Tal Biron-Shental
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel affiliated with Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Leisegang T, Stöcker H, Levin AA, Weissbach T, Zschornak M, Gutmann E, Rickers K, Gemming S, Meyer DC. Switching Ti valence in SrTiO3 by a dc electric field. Phys Rev Lett 2009; 102:087601. [PMID: 19257786 DOI: 10.1103/physrevlett.102.087601] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 12/19/2008] [Indexed: 05/27/2023]
Abstract
A (001) SrTiO3 wafer has been investigated in situ at room temperature under application of a static electric field of varying polarity by fluorescence x-ray absorption near edge structure (XANES) analysis at the Sr-K and Ti-K absorption edges. The XANES spectra show a clear shift of the Ti-K absorption edge energy. The shift is attributed to a change of the Ti valence state in a volume invoked by diffusion of the oxygen ions and vacancies. No shift was observed for the Sr-K absorption edge energy. Theoretical calculations support these findings.
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Affiliation(s)
- T Leisegang
- Institut für Strukturphysik, Technische Universität Dresden, 01062 Dresden, Germany.
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Stoecker H, Levin A, Gutmann E, Weissbach T, Leisegang T, Ritter S, Elschner C, Bobeth M, Pompe W, Meyer D. Reversible structural changes by electrostatic fields in strontium titanate at room temperature. Acta Crystallogr A 2008. [DOI: 10.1107/s010876730808505x] [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: 11/10/2022] Open
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Zschornak M, Leisegang T, Stoecker H, Weissbach T, Gemming S, Meyer D. Site-selective determination of coordination symmetries by anisotropic anomalous X-ray scattering. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308081531] [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: 11/11/2022] Open
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Levin A, Stoecker H, Ritter S, Weissbach T, Bilani-Zeneli O, Meyer D. Lattice strain tuning in SrTiO 3/La 0.7Sr 0.3MnO 3films by inverse piezoelectric effect of PMN–PT wafer. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308085152] [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: 11/10/2022] Open
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Weissbach T, Welfonder E. Improvement of the Performance of Scheduled Stepwise Power Programme Changes within the European Power System. ACTA ACUST UNITED AC 2008. [DOI: 10.3182/20080706-5-kr-1001.02026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Leisegang T, Weissbach T, Dshemuchadse J, Faulhaber E, Frontzek M, Stockert O, Souptel D, Behr G, Jeevan HS, Geibel C, Paufler P, Meyer DC. Influence of the Si content on the structure of rare-earth silicides. Acta Crystallogr A 2007. [DOI: 10.1107/s0108767307094937] [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: 11/10/2022] Open
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Leisegang T, Weissbach T, Faulhaber E, Stockert O, Jeevan HS, Geibel C, Paufler P, Meyer DC. Single crystal X-ray diffraction analysis of CeCu 2Si 2. Acta Crystallogr A 2006. [DOI: 10.1107/s0108767306094074] [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: 11/10/2022] Open
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