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Lurie S, Shalev A, Sadan O, Golan A. The changing indications and rates of cesarean section in one academic center over a 16-year period (1997–2012). Taiwan J Obstet Gynecol 2016; 55:499-502. [DOI: 10.1016/j.tjog.2014.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/16/2022] Open
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Lerner-Geva L, Glasser S, Levitan G, Boyko V, Golan A, Beloosesky R, Lunenfeld E, Many A, Samueloff A, Schiff E, Shoham A, Fisher M, Hirsh-Yechezkel G. A case-control study of caesarean delivery on maternal request: who and why? J Matern Fetal Neonatal Med 2015; 29:2780-5. [PMID: 26526785 DOI: 10.3109/14767058.2015.1103727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The current study aimed to evaluate the profile of women who are most likely to undergo caesarean delivery on maternal request (CDMR) and clarify their reasons for this decision. METHODS For this multicentre case-control study, data were collected from 429 women who underwent CDMR and 429 matched controls who delivered vaginally from June, 2008 through February, 2009. Participants were interviewed by telephone regarding sociodemographic variables, health and lifestyle. RESULTS CDMR predictors were as follows: increasing age (OR = 1.09/year; 95%CI: 1.05-1.14), family status (unmarried without a steady partner versus married - OR = 3.60; 95%CI: 1.08-11.97), decreasing level of religiosity (secular versus ultra-orthodox - OR = 11.82; 95%CI: 3.75-37.21), and never having engaged, or ceasing sports activity during pregnancy (OR = 1.79; 95%CI: 1.09-2.91 and 2.38; 95%CI: 1.28-4.43, respectively). Above average income reduced the probability of CDMR (OR = 0.56; 95%CI: 0.33-0.94). The most frequent reasons for choosing CDMR were concern for pain (21.9%), concern for their own or baby's health (20.4% and 16.5%, respectively) and emotional aspects (10.0%). CONCLUSIONS Older, unmarried and/or secular women had increased probability of CDMR. Addressing specific concerns regarding vaginal delivery may provide the basis for a patient-oriented intervention for preventing unnecessary surgery.
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Affiliation(s)
- Liat Lerner-Geva
- a Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research Ltd , Tel Hashomer , Israel .,b School of Public Health, Sackler Faculty of Medicine, Tel Aviv University , Israel
| | - Saralee Glasser
- a Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research Ltd , Tel Hashomer , Israel
| | - Gila Levitan
- a Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research Ltd , Tel Hashomer , Israel
| | - Valentina Boyko
- a Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research Ltd , Tel Hashomer , Israel
| | - Abraham Golan
- b School of Public Health, Sackler Faculty of Medicine, Tel Aviv University , Israel .,c Department of Obstetrics and Gynecology , Edith Wolfson Medical Center , Holon , Israel
| | - Ron Beloosesky
- d Department of Obstetrics and Gynecology , Rambam Medical Center , Haifa , Israel
| | - Eitan Lunenfeld
- e Department of Obstetrics and Gynecology , Soroka Medical Center , Beer Sheba , Israel
| | - Ariel Many
- b School of Public Health, Sackler Faculty of Medicine, Tel Aviv University , Israel .,f Maternity Department, Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Arnon Samueloff
- g Maternity Department and Pregnancy Complications Unit, Shaare Zedek Medical Center , Jerusalem , Israel
| | - Eyal Schiff
- b School of Public Health, Sackler Faculty of Medicine, Tel Aviv University , Israel .,h Department of Obstetrics and Gynecology , Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Ann Shoham
- h Department of Obstetrics and Gynecology , Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Menachem Fisher
- i Department of Medicine in the Galil , Safed Campus, Bar Ilan University , Safed , Israel
| | - Galit Hirsh-Yechezkel
- a Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research Ltd , Tel Hashomer , Israel
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Weiner E, Mizrachi Y, Keidar R, Kerner R, Golan A, Sagiv R. Laparoscopic surgery performed in advanced pregnancy compared to early pregnancy. Arch Gynecol Obstet 2015; 292:1063-8. [PMID: 25958071 DOI: 10.1007/s00404-015-3744-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of our study was to assess the clinical and obstetric outcomes of laparoscopic surgeries performed during advanced pregnancy compared to those performed in early pregnancy. METHODS We retrospectively reviewed all cases of patients who underwent laparoscopic surgery during pregnancy in our institution between 1996 and 2013. RESULTS We reviewed cases of 117 pregnant women who underwent laparoscopic surgery during the study period. There were no conversions to laparotomy. 71 surgeries were performed in the first trimester (group 1, mean gestational age 7.7 ± 1.9 weeks) and 46 were performed in the second and third trimesters (group 2, mean gestational age 18.1 ± 4.3 weeks). More patients in group 1 underwent surgery for suspected adnexal torsion (p < 0.001), while more patients in group 2 underwent surgery for presumptive cholecystitis (p = 0.014) and persistent ovarian mass (p = 0.011). The interval between admission and surgery differed significantly between the groups and was longer in group 2 compared to group 1 (18.2 ± 24.0 vs. 6.8 ± 10.6 h, p = 0.001). No difference was found between the two groups regarding surgical complications, histopathological findings and pregnancy outcomes. CONCLUSION In our experience, laparoscopic surgery in advanced pregnancy was found to be feasible and safe as in early pregnancy, without any adverse effects on pregnancy outcome.
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Affiliation(s)
- Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Halochamim St. 62, Holon, Israel
| | - Yossi Mizrachi
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Halochamim St. 62, Holon, Israel
| | - Ran Keidar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Halochamim St. 62, Holon, Israel
| | - Ram Kerner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Halochamim St. 62, Holon, Israel
| | - Abraham Golan
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Halochamim St. 62, Holon, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Halochamim St. 62, Holon, Israel.
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Sagiv R, Mizrachi Y, Glickman H, Kerner R, Keidar R, Bar J, Golan A. Laminaria vs. vaginal misoprostol for cervical preparation before second-trimester surgical abortion: a randomized clinical trial. Contraception 2015; 91:406-11. [PMID: 25646929 DOI: 10.1016/j.contraception.2015.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/07/2014] [Revised: 01/27/2015] [Accepted: 01/27/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the efficacy and tolerability of vaginal misoprostol and laminaria for cervical preparation before second-trimester surgical abortion. STUDY DESIGN We performed a prospective, randomized trial comparing midnight administration of misoprostol 600 mcg vaginally to midnight placement of laminaria, before surgical abortions among women at 13-20 weeks of gestation. The primary outcome was preoperative cervical dilation. Secondary outcomes were the need for further dilation, procedure duration and difficulty, immediate complications and side effects. RESULTS Eighty-four women were randomized, with a median gestational age of 16.5 weeks. The mean time interval between misoprostol and laminaria placement and dilatation and evacuation initiation was 11.0±2.9 and 11.2±2.0h, respectively (p=.17). Cervical dilation was not greater in the laminaria group as compared to the misoprostol group (12.8 vs. 12.4mm, respectively; p=.32). No difference was demonstrated regarding the need for additional dilation or the difficulty of the procedure. Procedures performed after laminaria insertion were 1 min longer (median 11 vs. 10 min, p=.04). Participants found laminaria placement more uncomfortable than vaginal misoprostol placement. Other than pain, additional side effects occurred only in the misoprostol group, primarily nausea and vomiting. One participant in the misoprostol group experienced fetal expulsion during the night before the intended procedure. CONCLUSION Either vaginal misoprostol or laminaria provides adequate dilation for second-trimester surgical abortion. Laminaria causes more pain at insertion and misoprostol causes more side effects. IMPLICATIONS STATEMENT We found that cervical preparation in an inpatient setting for approximately 11h with misoprostol 600 mcg vaginally is comparable to 11h of laminaria. However, given the potential for spontaneous expulsion and more side effects with misoprostol, laminaria is likely a better general option in such a setting.
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Affiliation(s)
- Ron Sagiv
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yossi Mizrachi
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hagit Glickman
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ram Kerner
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran Keidar
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abraham Golan
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Abstract
OBJECTIVE To assess the association between normal CA125 levels at diagnosis of epithelial ovarian carcinoma (EOC) with prognostic factors and with outcome. METHODS The study group consisted of histologically confirmed EOC patients with normal pretreatment CA125 levels, and the controls consisted of EOC patients with elevated (≥35 U/mL) pretreatment CA125 levels, diagnosed and treated between 1995 and 2112. Study and control group patients fulfilled the following criteria: 1) their pretreatment CA125 levels were assessed; 2) they had full standard primary treatment, i.e. cytoreductive surgery and cisplatin-based chemotherapy; and 3) they were followed every 2-4 months during the first two years and every 4-6 months thereafter. RESULTS Of 114 EOC patients who fulfilled the inclusion criteria, 22 (19.3%) had normal pretreatment CA125 levels. The control group consisted of the remaining 92 patients with ≥35 U/mL serum CA125 levels pretreatment. The proportion of patients with early-stage and low-grade disease, with optimal cytoreduction, and with platin-sensitive tumors was significantly higher in the study group than in the control group. The progression-free survival (PFS) and overall survival (OS) were significantly higher in the study group than in the control group on univariate analysis but not on multivariate analysis. CONCLUSION It seems that a normal CA125 level at diagnosis in EOC may also be of prognostic significance for the individual patient.
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Affiliation(s)
- Joseph Menczer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Erez Ben-Shem
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Abraham Golan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tally Levy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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Mizrachi Y, Weiner E, Keidar R, Kerner R, Golan A, Sagiv R. Intraoperative rupture of benign mucinous cystadenoma does not increase its recurrence rate. Arch Gynecol Obstet 2014; 291:1135-9. [DOI: 10.1007/s00404-014-3543-7] [Citation(s) in RCA: 5] [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: 09/15/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022]
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Menczer J, Schreiber L, Berger E, Ben-Shem E, Golan A, Levy T. CA125 expression in the tissue of uterine leiomyosarcoma. Isr Med Assoc J 2014; 16:697-699. [PMID: 25558698] [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: 06/04/2023]
Abstract
UNLABELLED Background: Elevated serum levels of the epithelial marker CA125 are occasionally observed in leiomyosarcoma (LMS) patients. OBJECTIVES To assess the immunohistochemical expression of this marker in the tissue of LMS. METHODS The consecutive unselected records of all patients with LMS diagnosed during the period 1995-2012 were located and abstracted. After verification of the diagnosis, 4 μm unstained slides were prepared from each case for immunohistochemical staining for CA125. Sections of ovarian carcinoma known to express CA125 were used as positive controls. RESULTS We located 17 LMS patients from the period under study. Bleeding was the presenting symptom in 9 patients; the diagnosis was established prior to treatment in 11 patients. The tumor was in an advanced stage in 6 patients, and in 7 unstaged patients it was grossly confined to the uterus. Ten patients died within 14 months after the diagnosis. Serum CA125 levels prior to treatment were assessed in only 8 patients and were above normal limits (> 35 U/ml) in 3 of them. Two of the three with elevated serum levels were in stage III, and the third was an unstaged apparent stage I patient. None of the LMS tissue specimens demonstrated immunohistochemical expression of CA125. CONCLUSIONS CA125 was not immunohistochemically expressed in the tissue of any LMS tumors examined by us. The origin of elevated serum CA125 in some of these tumors is therefore not in its tissue and remains unknown.
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Affiliation(s)
- Joseph Menczer
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel.
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Ginath S, Lurie S, Golan A, Amsterdam A, Sandbank J, Sadan O, Kovo M. The expression of heparanase in normal and preeclamptic placentas. J Matern Fetal Neonatal Med 2014; 28:1589-93. [PMID: 25189635 DOI: 10.3109/14767058.2014.962506] [Citation(s) in RCA: 10] [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: 11/13/2022]
Abstract
OBJECTIVE Heparanase plays a central role in processes of placentation. Abnormal placentation may result in inadequate uteroplacental blood flow, leading to unsuccessful pregnancy outcome and preeclampsia. We aimed to evaluate heparanase expression in placentas of preeclamptic patients. MATERIALS AND METHODS Placental tissue samples were collected immediately after delivery from 9 preeclamptic patients and 3 healthy controls at term, and were analyzed by immunohistochemistry, western blot analysis and real-time PCR, with regard to the presence of heparanase. RESULTS Immunohistochemistry staining for heparanase did not differ between normal and preeclamptic placental sections. On the other hand, western blot analysis revealed increased expression of heparanase in preeclpamptic placentas compared to controls, p = 0.001. Similarly, RT-PCR analysis showed also an increased expression of heparanase m-RNA compared to health controls, p = 0.005. CONCLUSION Heparanase is over expressed in preeclamptic placentas compared to normal healthy controls, suggesting its role in the development of preeclampsia.
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Affiliation(s)
- Shimon Ginath
- a Department of Obstetrics and Gynecology , Holon and Sackler Faculty of Medicine, Edith Wolfson Medical Center , Tel-Aviv , Israel
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Lurie S, Raz N, Boaz M, Sadan O, Golan A. Comparison of maternal outcomes from primary cesarean section during the second compared with first stage of labor by indication for the operation. Eur J Obstet Gynecol Reprod Biol 2014; 182:43-7. [PMID: 25218551 DOI: 10.1016/j.ejogrb.2014.08.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/06/2014] [Accepted: 08/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare maternal outcomes when cesarean sections were performed in the second stage of labor to those performed in the first stage of labor by indication for the operation. STUDY DESIGN This is a retrospective cohort (n=383) of term parturient women who underwent primary cesarean section during active labor. Cases were drawn from the Obstetrics Department, E. Wolfson Medical Center, a tertiary health care university facility, during a 24 month period. All cases were term singleton pregnancies in vertex presentation following unremarkable pregnancy. Maternal morbidity was assessed. RESULTS A significantly higher rate of unintentional uterine incision extensions was observed in cesarean sections performed during second stage compared to first stage (17.1% vs. 4.6%, p=0.001). It was higher whenever (at first or second stage) the fetal head was pushed (20.0% vs. 5.4%, p=0.0024). Unintentional uterine incision extensions were significantly more frequent when the cesarean section was performed for non-progressive labor during the second stage compared to first stage (16.1% vs. 3.6%, p=0.0052). Uterine atonia was more frequent among parturient women who underwent cesarean section for non-progressive labor during the first stage compared to second stage (16.7% vs. 4.8%, p=0.0382). CONCLUSION Uterine atony during first stage cesarean section and unintentional uterine incision extensions during second stage cesarean section were significantly more frequent when the operation was performed for non-progressive labor.
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Affiliation(s)
- Samuel Lurie
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nili Raz
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Mona Boaz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Epidemiology and Statistics Unit, Edith Wolfson Medical Center, Holon, Israel
| | - Oscar Sadan
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Golan
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lurie S, Weiner E, Golan A, Sadan O. Total and Differential Leukocyte Count Percentiles in Healthy Singleton Term Women during the First Stage of Labor. Gynecol Obstet Invest 2014; 78:251-4. [DOI: 10.1159/000365084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 06/04/2014] [Indexed: 11/19/2022]
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Wand S, Weissman A, Sagiv R, Schreiber L, Boaz M, Horowitz E, Ravhon A, Seadia S, Barkat J, Golan A, Lavran D. Endometrial nerve fibre density in patients undergoing IVF: a pilot study. Reprod Biomed Online 2014; 28:761-5. [PMID: 24745833 DOI: 10.1016/j.rbmo.2014.02.007] [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: 09/22/2013] [Revised: 12/14/2013] [Accepted: 02/11/2014] [Indexed: 11/16/2022]
Abstract
The presence of nerve fibres in the functional layer of the endometrium has been strongly associated with endometriosis. Presence of nerve fibres in the endometrium of women undergoing IVF has not been previously assessed. This prospective pilot study assessed the presence of nerve fibres in endometrium of women undergoing IVF due to various causes and examined the correlation between the presence of nerve fibres and IVF success. A total of 32 IVF patients underwent endometrial biopsy during days 21-23 of the menstrual cycle. Nerve fibres were identified by immunohistochemical staining. Correlations between the presence and density of nerve fibres and aetiology of infertility and IVF success were measured. Nerve fibres were identified in the endometrium of 10/31 (32.3%) women with a satisfactory biopsy. Presence of nerve fibres was not correlated with cause of infertility. Clinical pregnancy was achieved in 12/32 (37.5%) patients, without correlation to presence of nerve fibres in the endometrium. Nerve fibres were identified in a substantial percentage of women undergoing IVF, possibly reflecting underdiagnosis of endometriosis in this population. The presence of nerve fibres does not appear to interfere with implantation. The significance of nerve fibres in the endometrium of IVF patients warrants further research. The presence of nerve fibres in the functional layer of the endometrium has been strongly associated with endometriosis. The presence of nerve fibres in the endometrium of women undergoing IVF has not been previously assessed. Our aim was to assess the presence of nerve fibres in endometrium of women with various causes of infertility undergoing IVF and to examine the association between the presence of nerve fibres in the endometrium and IVF success. In a prospective study, 32 IVF patients underwent endometrial biopsy during days 21-23 of the menstrual cycle. Nerve fibres were identified by immunohistochemical staining. Associations between the presence and density of nerve fibres and the aetiology of infertility and IVF success were measured. Nerve fibres were identified in the endometrium of 10/31 (32.3%) women with a satisfactory biopsy. No association was found between the presence of nerve fibres and the cause of infertility. Clinical pregnancy was achieved in 12/32 (37.5%) patients, without association with the presence of nerve fibres in the endometrium. Nerve fibres can be identified in a substantial percentage of women undergoing IVF, possibly reflecting underdiagnosis of endometriosis in this population. Their presence does not interfere with embryo implantation. The significance of nerve fibres in the endometrium of IVF patients warrants further research.
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Affiliation(s)
- Suzanna Wand
- IVF Unit, Edith Wolfson Medical Center, Holon, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Weissman
- IVF Unit, Edith Wolfson Medical Center, Holon, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mona Boaz
- Epidemiology and Research Unit, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Horowitz
- IVF Unit, Edith Wolfson Medical Center, Holon, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Ravhon
- IVF Unit, Edith Wolfson Medical Center, Holon, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarit Seadia
- IVF Unit, Edith Wolfson Medical Center, Holon, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Barkat
- IVF Unit, Edith Wolfson Medical Center, Holon, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Golan
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Lavran
- IVF Unit, Edith Wolfson Medical Center, Holon, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weiner E, Bar J, Fainstein N, Ben-Haroush A, Sadan O, Golan A, Kovo M. The effect of a program to shorten the decision-to-delivery interval for emergent cesarean section on maternal and neonatal outcome. Am J Obstet Gynecol 2014; 210:224.e1-6. [PMID: 24565432 DOI: 10.1016/j.ajog.2014.01.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 11/14/2013] [Revised: 12/21/2013] [Accepted: 01/07/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the effect of a departmental program designed to shorten the decision-to-delivery interval (DDI) for emergency cesarean section (ECS) for nonreassuring fetal heart rate (NRFHR) on maternal and neonatal outcome. STUDY DESIGN A protocol for managing ECS that included documenting precise time-intervals, identification of delaying obstacles and debriefing of each case, was implemented from March 2011. All women who delivered by ECS for NRFHR, as the only indication were included. Detailed information regarding DDI, maternal intraoperative and postoperative complications, and neonatal early outcomes were compared before (period-P1) (-27 months) and after (period 2) (+27 months) program implementation. RESULTS During 54 months of study, 593 ECS DDI were included. Mean DDI decreased at period 2 (12.3 ± 3.8 min, n = 301) compared with period 1 (21.7 ± 9.1 min, n = 292), P < .001. Rate of cord pH ≤7.1 and 5 min Apgar score ≤7 decreased at period 2 compared with period 1, P = .016 and P = .031, respectively. Worse composite neonatal outcome decreased at period 2 compared with period 1, 15.6% vs 32.2%, respectively, P ≥ .001. Composite maternal outcome did not differ between the groups. Worse neonatal outcome was dependent on time period (period 1), odds ratio, 2.12; 95% confidence interval, 1.27-3.55; P = .004 and on gestational age at delivery, odds ratio, 0.68; 95% confidence interval, 0.62-0.76; P < .001. CONCLUSION Introduction of a management protocol to shorten DDI in ECS for NRFHR was associated with improved early neonatal outcome without change in maternal complications.
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Affiliation(s)
- Eran Weiner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Jacob Bar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Nataly Fainstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Avi Ben-Haroush
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Rabin Medical Center, Petah-Tikva, Israel
| | - Oscar Sadan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Abraham Golan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Michal Kovo
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
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Sagiv R, Debby A, Keidar R, Kerner R, Golan A. Laparoscopic Conservative Treatment of Ovarian Pregnancy and Subsequent Fertility Outcome. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ron Sagiv
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Abraham Debby
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Ran Keidar
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Ram Kerner
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Abraham Golan
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Weiner E, Bar J, Fainstein N, Ben-Haroush A, Sadan O, Golan A, Kovo M. 28: The effect of a program to shorten the decision-to-delivery interval for emergent cesarean section on maternal and neonatal outcome. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Sexual re-victimisation refers to a pattern in which the sexual assault victim has an increased risk of subsequent victimisation relative to an individual who was never victimised. The purpose of our study was to identify risks factors for a second rape, the severest form of sexual re-victimisation. All rape victims treated at the First Regional Israeli Center for Sexual Assault Victims between October 2000 and July 2010 were included in this retrospective analysis. We compared characteristics of 53 rape victims who were victimised twice to those of 1,939 rape victims who were victimised once. We identified several risk factors for a second rape, which can be used in prevention programmes. These are: psychiatric background, history of social services involvement, adulthood, non-virginity and minority ethnicity.
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Affiliation(s)
- S Lurie
- Department of Obstetrics and Gynecology
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Lurie S, Ribenzaft S, Boaz M, Golan A, Sadan O. The effect of cigarette smoking during pregnancy on mode of delivery in uncomplicated term singleton pregnancies. J Matern Fetal Neonatal Med 2013; 27:812-5. [PMID: 24020824 DOI: 10.3109/14767058.2013.842551] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the influence of cigarette smoking during pregnancy on mode of delivery. METHODS A retrospective analysis of 6105 uncomplicated term singleton pregnancies for mode of delivery was performed with respect to smoking status. RESULTS Of all, 680 (84.0%) smokers and 4588 (86.7%) non-smokers had a spontaneous vaginal delivery, 65 (8.0%) smokers and 393 (7.4%) non-smokers had an instrumental delivery and 65 (8.0%) smokers and 314 (5.9%) non-smokers had a cesarean delivery (p = 0.051). Smoking during pregnancy increased the risk of any operative or instrumental intervention by OR 1.240, 95% CI 1.012-1.523. Non-reassuring fetal heart rate pattern that warranted either cesarean or instrumental intervention was present in 99 (12.2%) out of 810 smokers and in 392 out of 5295 (7.4%) non-smokers, p < 0.001). Smoking during pregnancy increased the risk of non-reassuring fetal heart rate pattern that warranted either cesarean or instrumental intervention by OR 1.650 (95% CI 1.341-2.022). CONCLUSION Women with uncomplicated term singleton pregnancies who smoke during pregnancy are at an increased risk of fetal compromise during labor (as judged by non-reassuring fetal heart rate pattern), leading to increased rates of operative delivery (cesarean either instrumental).
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Affiliation(s)
- Samuel Lurie
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center , Holon , Israel
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17
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Sagiv R, Debby A, Keidar R, Kerner R, Golan A. Interstitial pregnancy management and subsequent pregnancy outcome. Acta Obstet Gynecol Scand 2013; 92:1327-30. [DOI: 10.1111/aogs.12239] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 08/01/2013] [Indexed: 11/29/2022]
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18
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Weissman A, Ravhon A, Steinfeld Z, Nahum H, Golan A, Levran D. Controlled ovarian stimulation using a long gonadotropin-releasing hormone antagonist protocol: a proof of concept and feasibility study. Gynecol Obstet Invest 2013; 76:113-8. [PMID: 23920048 DOI: 10.1159/000351570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To evaluate the feasibility of a long protocol of controlled ovarian stimulation prior to in vitro fertilization (IVF) and embryo transfer with a gonadotropin-releasing hormone (GnRH) antagonist used for pituitary and ovarian suppression. METHODS Thirty patients undergoing IVF/intracytoplasmic sperm injection were randomized into two groups. The control group (n = 16) received a standard flexible GnRH antagonist protocol. Ovarian stimulation consisted of 225 IU/day of recombinant follicle-stimulating hormone for 5 days, followed by 225 IU/day of human menopausal gonadotropin until human chorionic gonadotropin (hCG) administration. The study group (n = 14) received 0.25 mg of GnRH antagonist daily for 7 days, thereafter, upon confirmation of pituitary and ovarian suppression, ovarian stimulation was commenced with the same protocol as used in the control group. Hormone and follicle dynamics, as well as laboratory characteristics and cycle outcome, were compared for both groups. RESULTS Both groups were comparable in baseline characteristics. Pituitary and ovarian suppression were effectively achieved in 12/14 patients in the study group. The duration of ovarian stimulation and gonadotropin consumption were similar in both groups, as was also the number and size of follicles on hCG day. CONCLUSION The results of our study confirm the feasibility of a long GnRH antagonist protocol. This regimen could become another option to optimize GnRH antagonist protocols, and should thus be further explored.
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Affiliation(s)
- Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
OBJECTIVES To assess whether labor length differs by week of gestation. METHODS In this observational cross-sectional study, we compared duration of labor by gestational age (36 + 0 through 40 + 6 weeks) in primiparous singleton parturients with vertex presentation. Data were acquired for a period of 24 months (2010-2011). RESULTS In general, the rate of change in cervical dilatation decreased as gestational week at delivery advanced: 1.8 ± 1.0 cm/h, 1.5 ± 0.9 cm/h, 1.3 ± 0.8 cm/h, 1.6 ± 1.5, and 1.3 ± 1.0 cm/h at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p = 0.040). Concurrently, the total labor duration (1st + 2nd + 3rd stages) increased as gestational age advanced: 423.6 ± 180.9 min, 496.5 ± 212.6 min, 545.9 ± 247.1 min, 483.8 ± 256.3 min, and 568.2 ± 273.8 min at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p = 0.013). CONCLUSIONS Gestational week of pregnancy may alter the duration of labor, specifically, the length of labor increases as gestational week at delivery advances.
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Affiliation(s)
- Samuel Lurie
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center , Holon , Israel
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Ginath S, Shalev A, Keidar R, Kerner R, Condrea A, Golan A, Sagiv R. Differences between adnexal torsion in pregnant and nonpregnant women. J Minim Invasive Gynecol 2013; 19:708-14. [PMID: 23084674 DOI: 10.1016/j.jmig.2012.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 07/24/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To compare the clinical manifestation, management, and outcome of adnexal torsion in pregnant and nonpregnant women. DESIGN Retrospective case-control study (Canadian Task Force classification II-3). SETTING Tertiary care university hospital. PATIENTS Sixty-four pregnant women and 198 nonpregnant women with episodes of adnexal torsion. INTERVENTIONS Surgery to treat proved adnexal torsion. MEASUREMENTS AND MAIN RESULTS The mean (SD) gestational age in the pregnant group was 11.5 (7.7) weeks. Thirty six episodes of adnexal torsion in the pregnant group (56%) developed after treatment for infertility, compared with only 14 such episodes (7%) in the nonpregnant group (p < .001). A repeated episode of torsion occurred more frequently in the pregnant group (14% vs 4%; p = .03). Sonographic demonstration of multicystic ovaries was more common in pregnant women with recurrent torsion than in women with a single episode of torsion (86% vs 31%; p = .009). Tissue preservation was achieved more frequently in pregnant than in nonpregnant patients (95% vs 77%; p < .001), and the duration of surgery was 15 minutes shorter in the pregnant women (p < .001). CONCLUSION Pregnancy after treatment for infertility is a risk factor for adnexal torsion. Recurrence of ovarian torsion occurs more frequently in pregnant patients, and in particular in enlarged multicystic ovaries.
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Affiliation(s)
- Shimon Ginath
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel.
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Lurie S, Steinberg N, Tannus S, Golan A, Sadan O. Mode of delivery in a subsequent pregnancy following previous instrumental delivery. J Perinat Med 2013; 41:283-6. [PMID: 23241581 DOI: 10.1515/jpm-2012-0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 11/05/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess mode of subsequent delivery in women with previous instrumental vaginal delivery. STUDY DESIGN In this retrospective longitudinal study we followed women who underwent instrumental delivery. The study group included all consecutive parturient women who underwent an instrumental vaginal delivery during a 24-month period (1996-1999). We then identified women who had a subsequent delivery in our center until the end of the year 2010. The control group included women who had a spontaneous vaginal delivery from the same time. RESULTS During the index period we had 349 consecutive successful instrumental vaginal deliveries. Of those, 125 women had a subsequent delivery in our center (35.8%). In subsequent pregnancies, the spontaneous vaginal delivery rate was 76.8% and 90.4%; the instrumental delivery rate was 8.8% and 1.6%; and the cesarean rate was 14.4% and 8.0%, in the instrumental delivery, and spontaneous vaginal delivery groups, respectively (P<0.05). The odds ratio for a woman to undergo either an instrumental delivery or a cesarean after having an instrumental delivery in a previous pregnancy was 2.8 (95% confidence interval 1.4-5.9, P<0.05). CONCLUSION Women with a previous instrumental delivery are at an increased risk of requiring either an instrumental delivery or a cesarean section in a subsequent pregnancy compared with women with a previous spontaneous vaginal delivery.
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Affiliation(s)
- Samuel Lurie
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
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Tannus S, Weissman A, Boaz M, Horowitz E, Ravhon A, Golan A, Levran D. The effect of delayed initiation of gonadotropin-releasing hormone antagonist in a flexible protocol on in vitro fertilization outcome. Fertil Steril 2013; 99:725-30. [DOI: 10.1016/j.fertnstert.2012.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
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23
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Menczer J, Ben-Shem E, Golan A, Levy T. The effect of coexisting uterine myomas on clinico-pathological variables of endometrial carcinoma. EUR J GYNAECOL ONCOL 2013; 34:545-547. [PMID: 24601048] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To assess the prevalence of leiomyomas in patients with endometrial carcinoma (EC) and the association of their presence with clinico-pathological variables and with survival. MATERIALS AND METHODS A retrospective chart review was conducted of all endometrial carcinoma (EC) patients diagnosed and treated in the present institution between 2002 and 2008. Selected clinical data were abstracted from medical records. Pathological data such as the presence of myomas (any size), tumor grade, depth of myometrial invasion presence of lymphovascular space involvement (LVSI), and the presence of metastases, are based on the original pathology report. RESULTS Coexisting myomas were found in 74 (56.9%) of 130 EC patients diagnosed during the study period. No significant difference with regard to age, histological type, stage, grade, depth of myometrial invasion, LVSI, lymph node involvement, and presence of metastases (other than lymph node involvement) was found between patients without and with myomas. There was also no significant difference in survival of EC patients without and with coexistent myomas. CONCLUSION The present data seem to indicate that the presence of myomas does not affect clinico-pathological variables of EC patients nor their survival.
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Affiliation(s)
- J Menczer
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel.
| | - E Ben-Shem
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - A Golan
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - T Levy
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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Kovo M, Schreiber L, Ben-Haroush A, Cohen G, Weiner E, Golan A, Bar J. 436: The placental factor in early and late normotensive growth restriction. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.602] [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: 11/28/2022]
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25
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Levy T, Weiser R, Boaz M, Ben Shem E, Golan A, Menczer J. The significance of the pattern of serum CA125 level ascent to above the normal range in epithelial ovarian, primary peritoneal and tubal carcinoma patients. Gynecol Oncol 2012; 129:165-8. [PMID: 23274778 DOI: 10.1016/j.ygyno.2012.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/10/2012] [Accepted: 12/12/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A rise of the CA125 marker above the normal range during follow-up of ovarian, primary peritoneal and tubal carcinoma patients with a complete clinical response after initial treatment signifies recurrence. We assessed whether the pattern of CA125 ascent to above the normal range at recurrence is associated with outcome. METHODS The records of all recurrent ovarian primary peritoneal and tubal carcinoma patients diagnosed during 1998-2007 were abstracted. Included were patients who fulfilled the following criteria: CA125 levels were ≥35 U/mL at diagnosis and at recurrence, they had full primary treatment with a complete clinical and radiographic response, were followed-up according to schedule, and had at least two CA125 results within the normal range during follow-up. Two patterns of CA125 ascent to above the normal range were compared: a gradual rise and an abrupt rise. RESULTS 52 patients with recurrent disease who met the inclusion criteria were identified. The median progression free and overall survival were significantly longer in patients with a gradual than in those with an abrupt rise (22.96 vs 14.07; P=0.0014; and 44.37 vs. median not yet reach, respectively). Multivariate analysis showed that the pattern of CA125 ascent is an independent predictor of progression free and overall survival. CONCLUSIONS Our data seem to indicate that at recurrence the pattern of ascent of serum CA125 levels to above the normal range in patients in complete clinical remission is of prognostic value.
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Affiliation(s)
- Tally Levy
- Division of Gynecologic Oncology, E. Wolfson Medical Center, Holon, Israel.
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Bar J, Schreiber L, Ben-Haroush A, Ahmed H, Golan A, Kovo M. The placental vascular component in early and late intrauterine fetal death. Thromb Res 2012; 130:901-5. [DOI: 10.1016/j.thromres.2012.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 09/10/2012] [Accepted: 09/18/2012] [Indexed: 11/30/2022]
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Golan A, Dishi-Galitzky M, Barda J, Lurie S. The care of sexual assault victims: the first regional center in Israel--10 years experience. Isr Med Assoc J 2012; 14:658-661. [PMID: 23240368] [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: 06/01/2023]
Abstract
BACKGROUND The management of sexual assault victims comprises complex medical, psychological, social and judicial care that was previously provided by various disciplines at several distant locations. This novel concept is the delivery of comprehensive care to victims of sexual assault at one location 24 hours a day. OBJECTIVES To describe the characteristics of sexual assault victims, their assailants, the assault and the treatment, and provide descriptive data on the evidentiary examination. METHODS We performed a retrospective analysis of the charts of all sexual assault victims presenting to the Regional Center for Care of Sexual Assault Victims between October 2000 and July 2010. The center, the first in Israel, provides comprehensive care to victims of sexual assault in one location 24 hours a day using a multidisciplinary approach. RESULTS The study group comprised 1992 subjects; 91.5% of the victims were females and 8.5% were males, and the age ranged from 1 to 88 years (mean age 22.3 years). Of the 1992 victims, 1635 were single (82.2%), 195 were divorced (9.8%), 141 were married (7.1%), 18 were widowed (0.9%) and 3 were unspecified. The assailant was a stranger in 794 (39.8%) of the cases, someone familiar to the victim in 786 cases (39.0%), a partner in 127 cases (6.4%), a family member in 117 cases (5.9%), someone met via the internet in 53 cases (2.7%), an authority figure in 39 cases (2.0%), and unspecified in 76 (3.9%). In the majority of cases the attack occurred either in the evening or at night (71.7%). CONCLUSIONS We identified several risk factors for sexual assault that can be used in prevention programs. The sexual assault victim in our study tended to be a young single woman who was attacked by a familiar assailant in the evening or at night. Our center provides comprehensive care to victims 24 hours a day at one location and includes a team of forensic, psychological, physical and legal specialists.
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Affiliation(s)
- Abraham Golan
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Luria O, Barnea O, Shalev J, Barkat J, Kovo M, Golan A, Bar J. Two-dimensional and three-dimensional Doppler assessment of fetal growth restriction with different severity and onset. Prenat Diagn 2012; 32:1174-80. [PMID: 23074059 DOI: 10.1002/pd.3980] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To investigate the role of three-dimensional (3D) power Doppler ultrasonography in the assessment of fetal growth-restriction (FGR) with various degrees of severity and onset, and compare the results with the analysis of two-dimensional (2D) Doppler. STUDY DESIGN Vascular indices extracted from 3D Doppler measurements of the placenta were compared with indices of flow-velocity waveforms extracted from 2D Doppler measurements of the major sites of the fetal circulation between FGR (study group) and uncomplicated pregnancies (control group) from 25 to 38 weeks' gestation. RESULTS Three-dimensional indices were significantly lower in pregnancies complicated by FGR compared with uncomplicated pregnancies. When measured in placental periphery, vascularization index was 9.4 ± 9.6 in FGR pregnancies compared with 16 ± 14.7, P = 0.04. Flow index was 33.9 ± 6.9 compared with 38.7 ± 4.9, P = 0.03 and the vascularization-flow index was 3.8 ± 4.3 compared with 6.5 ± 6, respectively, P = 0.03. Among the conventional 2D indices, umbilical artery and middle cerebral artery pulsatility indices were not significantly different between the FGR and control groups. Higher rate of maternal or fetal compartment vascular lesions were detected in the FGR group. CONCLUSIONS Three-dimensional Doppler was found to be more strongly associated with placental vascular compromise than conventional 2D Doppler, regardless of severity and onset of fetal growth restriction.
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Affiliation(s)
- Oded Luria
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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Abstract
OBJECTIVES To investigate the placental role in uncomplicated pregnancies and spontaneous term labor. METHODS Placentas were retrieved from women with uncomplicated pregnancies and compared between those with spontaneous term labor to those with elective cesarean delivery without labor. Placentas were analyzed for lesions consistent with maternal circulation abnormalities, lesions consistent with fetal thrombo-occlusive disease and inflammatory lesions, maternal or fetal responses. RESULTS The study included 139 pregnancies, 76 with term spontaneous deliveries (cases) and 63 with term elective cesarean deliveries (controls). Maternal age, gravidity, parity and BMI were significantly lower in the study group, but gestational age was higher as compared with the control group. Higher rate of maternal inflammatory lesions was observed in the study group compared to the control group, 21 vs. 1.6%, respectively, p = 0.001. No differences were observed in vascular lesions or in fetal inflammatory lesions between the groups. CONCLUSION Placental maternal inflammatory changes play a role in spontaneous term labor, different from the involvement of the fetal compartment and placental vascular component in preterm labor.
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Affiliation(s)
- Jacob Bar
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel
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Lurie S, Baider C, Glickman H, Golan A, Sadan O. Are enemas given before cesarean section useful? A prospective randomized controlled study. Eur J Obstet Gynecol Reprod Biol 2012; 163:27-9. [DOI: 10.1016/j.ejogrb.2012.03.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/17/2012] [Accepted: 03/26/2012] [Indexed: 11/29/2022]
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Kovo M, Schreiber L, Ben-Haroush A, Gold E, Golan A, Bar J. The placental component in early-onset and late-onset preeclampsia in relation to fetal growth restriction. Prenat Diagn 2012; 32:632-7. [PMID: 22565848 DOI: 10.1002/pd.3872] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 02/14/2012] [Accepted: 02/14/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify pathological placental differences between early-onset and late-onset preeclampsia, in relation to fetal growth restriction (FGR). METHODS Placentas from patients with preeclampsia were analyzed for lesions of maternal vascular supply consistent with maternal underperfusion and lesions of fetal vascular supply consistent with fetal thrombo-occlusive disease. Findings were compared between patients who gave birth before 34 weeks (early-onset preeclampsia) and after 34 weeks (late-onset preeclampsia). RESULTS Compared with the late-onset group (n = 93), the early-onset group (n = 37) had higher rates of FGR (62.2% vs 25.8%, P < 0.001) and lesions of maternal vascular supply (95% vs 60%, P < 0.001). Within the early-onset group, cases with FGR (n = 23) had more lesions of fetal vascular supply (47.8% vs 7%, P = 0.01), with similar high rates of lesions of maternal vascular supply (91% vs 100%) compared with those without FGR. Within the late-onset preeclampsia group, cases with FGR (n = 24) had higher rates of maternal vascular supply lesions (88% vs 51%, P = 0.003) than those without FGR, but similar rates of fetal vascular supply lesions (25% vs 16%, P = 0.32). CONCLUSION The placental fetal vascular supply lesions in combination with maternal vascular lesions are more dominant in early-onset preeclampsia with FGR as compared with early-onset preeclampsia without FGR.
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Affiliation(s)
- Michal Kovo
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
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Luria O, Bar J, Barnea O, Golan A, Kovo M. Reactivity of blood vessels in response to prostaglandin E2 in placentas from pregnancies complicated by fetal growth restriction. Prenat Diagn 2012; 32:417-22. [PMID: 22495578 DOI: 10.1002/pd.3827] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The authors aimed to study the contractility responses of normal and fetal growth restriction (FGR) placentas to prostaglandin E(2) (PGE(2) ) and to correlate the results to subsequent placental histological analysis. METHOD A dual-perfused single cotyledon model was used. Placentas from pregnancies complicated by FGR and from normal pregnancies were obtained. Selected cotyledons were cannulated and dually perfused. Following stabilization, three concentrations of PGE(2) (0.05, 0.1, and 0.15 mg/mL) were administered to the fetal arterial side causing contraction/relaxation response. Fetal perfusion pressure was measured continuously during these contraction and relaxation phases. Following the perfusion experiments, the placentas were analyzed for fetal or maternal origin vascular lesions. RESULTS A total of 21 complete experiments were performed (16 normal, 5 FGR). In response to PGE(2) , FGR placentas exhibited lower change in the perfusion pressure and lower relaxation time constant. Basal perfusion pressure did not differ significantly between the two groups. Placental histopathology lesions, fetal or maternal origin, were more common in the FGR compared with the controls placentas, 80% versus 25%, respectively, P= 0.047. CONCLUSIONS The lower vascular reactivity in response to PGE(2) and the presence of fetal and maternal vascular placental lesions suggest a mechanism explaining the altered vascular supply in FGR.
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Affiliation(s)
- Oded Luria
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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Abstract
The use of dehydroepiandrosterone (DHEA) supplementation in infertile patients with diminished ovarian reserve (DOR) has become increasingly popular. It has been our observation that serum progesterone levels during the follicular phase are often increased during controlled ovarian stimulation when DHEA is coadministered. Our aim was to compare progesterone levels during the follicular phase before and during DHEA supplementation in women with DOR undergoing in vitro fertilization (IVF). In a case-control study, we compared progesterone levels during the follicular phase in IVF cycles before and during DHEA supplementation in 15 women with DOR who received 75 mg of DHEA daily. Progesterone levels on stimulation day 5 (0.5 ± 0.29 ng/ml vs. 1.54 ± 0.49 ng/ml; p < 0.0001) and on the day of human chorionic gonadotropin administration (0.75 ± 0.31 ng/ml vs. 1.87 ± 0.49 ng/ml; p < 0.0001) were significantly higher during DHEA treatment. The number of retrieved and fertilized oocytes was similar in both the groups. DHEA administration during IVF cycles in women with DOR causes a significant elevation of progesterone levels without an apparent deleterious effect on cycle outcome.
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Affiliation(s)
- Ariel Weissman
- Department of Obstetrics and Gynecology, IVF Unit, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Condrea A, Netzer I, Ginath S, Eldor-Itskovitz J, Golan A, Lowenstein L. Is mesh becoming more popular? Dilemmas in urogynecology: a national survey. Obstet Gynecol Int 2011; 2012:672356. [PMID: 22190956 PMCID: PMC3236431 DOI: 10.1155/2012/672356] [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] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 09/13/2011] [Accepted: 09/19/2011] [Indexed: 11/18/2022] Open
Abstract
The use of vaginal mesh in pelvic organ prolapse (POP) repair surgery has become more common in recent years. The purpose of the current study was to evaluate the common practice of Israeli urogynecologists, and to determine whether surgical practice has changed over the last two years. Methods. In 2009 and again in 2011, a survey was mailed to all urogynecologists affiliated with an academic institute in Israel. The survey consisted of 7 Likert-scale items and 3 open questions; the latter inquired about preferred type of surgery in three clinical scenarios. Results. Of 22 practitioners, 15 responded to the survey. The number of urogynecologists who reported using vaginal mesh for the repair of primary POP increased from 47 to 67% from 2009 to 2011. The number who would not use vaginal mesh in POP repair of elderly patients dropped from 60 to 3%. Finally, for the treatment of a 35-year-old patient with stage III uterine prolapse who desired to preserve fertility, 13% recommended the used vaginal mesh in 2009 compared with 47% in 2011. Conclusion. A survey of practitioners shows that the use of vaginal mesh for the repair of primary and recurrent pelvic organ prolapse has become more common among Israeli urogynecologists.
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Affiliation(s)
- Alexander Condrea
- Edith Wolfson Medical Center, 62 HaLohamim Street, P.O. Box 5, Holon 58100, Israel
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Kovo M, Schreiber L, Ben-Haroush A, Shor S, Golan A, Bar J. Intrapartum fever at term: clinical characteristics and placental pathology. J Matern Fetal Neonatal Med 2011; 25:1273-7. [PMID: 21992451 DOI: 10.3109/14767058.2011.629248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate the association between clinical characteristics and placental histopathology in women with intrapartum fever (IPF) at term. METHODS Maternal characteristics, intrapartum parameters, neonatal outcome and placental pathology were compared between 120 patients with IPF (≥ 380C) and a control group matched for mode of delivery. Placental lesions were classified as consistent with maternal circulation abnormalities or fetal thrombo-occlusive disease or inflammatory responses of maternal (MIR) or fetal (FIR) origin. RESULTS Compared to controls the study group was characterized by significantly higher rates of nulliparity, extra-amniotic balloon induction of labor, and epidural anesthesia, higher gestational age, higher white blood cell count, and more vaginal examinations. On multivariate logistic regression analysis, multiple vaginal examinations were independently associated with IPF. MIR was detected in 71% of the study group compared to 21% of controls (p < 0.001), and FIR, in 32.5% and 7.5%, respectively (p < 0.001). IPF was independently associated with inflammation of maternal origin (adjusted odds ratio (OR) 8.0, 95% CI 4.2-15.2, p < 0.001) and fetal origin (adjusted OR 5.2, 95% CI 2.07-13.4, p < 0.001). Neonatal outcome was similar in the two groups. CONCLUSIONS Multiple vaginal examinations are a significant risk factor for the development of IPF. IPF at term is independently associated with placental inflammatory lesions.
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Affiliation(s)
- Michal Kovo
- Department of Obstetrics & Gynecology and, The Edith Wolfson Medical Centerand, Holon, Israel.
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Abstract
OBJECTIVES To investigate both the psychological traits and the demographic factors associated with cesarean section on maternal demand. DESIGN Cross-sectional questionnaire study. SETTING Delivery ward, Edith Wolfson Medical Center, Holon, Israel. SAMPLE Fifty-nine healthy primigravida with a singleton pregnancy were recruited during 2009, of whom 28 requested and were delivered by cesarean section without obstetrical indication, whereas 31 opted for spontaneous vaginal delivery. METHODS All questionnaires were administered to the two groups at term. Various psychological (fear of childbirth questionnaire, Millon Clinical Multiaxial Inventory III, Anxiety Sensitivity Index, State-Trait Anxiety Index and social support scale) as well as demographic variables were measured before labor and compared. A priori power calculation yielded a power of 95%. MAIN OUTCOME MEASURES Fear of childbirth, various personality disorders and psychiatric clinical syndromes (29 Millon Clinical Multiaxial Inventory III scales), Anxiety Sensitivity, State Anxiety Index, social support and demographic variables. RESULTS Differences in age and method of conceiving (p<0.001) were found between the groups. The study group reported a higher level of fear of childbirth (p<0.001), but no differences were found in all other personality characteristics measured (29 Millon Clinical Multiaxial Inventory III scales, State-Trait Anxiety, Anxiety Sensitivity and social support scale). The origin of the difference regarding the fear of childbirth was located to two specific questions: 'Have you always been afraid of giving birth?' and 'Have you sometimes thought of the delivery as something unnatural?' CONCLUSIONS The only psychological variable associated with the choice for cesarean section on maternal request was the fear of childbirth.
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Affiliation(s)
- Jonathan E Handelzalts
- The Academic College of Tel Aviv-Yaffo, Department of Psychology, Tel Aviv-Yaffo, Israel Wolfson Medical Center, Department of Obstetrics & Gynecology, Holon, Israel
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Menczer J, Usviatzov I, Ben-Shem E, Golan A, Levy T. Neoadjuvant chemotherapy in ovarian, primary peritoneal and tubal carcinoma: can imaging results prior to interval debulking predict survival? J Gynecol Oncol 2011; 22:183-7. [PMID: 21998761 PMCID: PMC3188717 DOI: 10.3802/jgo.2011.22.3.183] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 05/16/2011] [Accepted: 05/17/2011] [Indexed: 12/03/2022] Open
Abstract
Objective To assess whether there is an association between improvement of computed tomography imaging results prior to interval debulking with survival in patients treated by neoadjuvant chemotherapy. Methods The clinical and outcome data of all advanced ovarian, primary peritoneal and tubal carcinoma patients who after diagnosis had neoadjuvant chemotherapy and underwent interval debulking during the period 2000-2010, were abstracted. Results of computed tomography imaging at diagnosis and prior to interval debulking were compared. Two parameters were assessed: the change of the size and number of abnormal findings and the change in the amount of ascites. CA-125 level response was also calculated. An assessment of progression free survival and of survival by the Kaplan-Meier method was made according to the change in computed tomography imaging results and according to response of CA-125 levels. Results The median progression free survival and the median survival of the 37 study group patients were 7.9 and 49.2 months respectively. No significant difference in progression free survival and survival was observed between patients with marked improvement in the computed tomography results and those with less desirable results (7.93 vs. 7.23 months respectively, p=0.89; 45.8% vs. 52.5% months respectively, p=0.95). There were also no statistically significant difference according to CA-125 level response. Conclusion It seems that neither improvement in imaging results nor CA-125 level response can predict the survival of ovarian carcinoma patients prior to interval debulking after neoadjuvant chemotherapy.
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Affiliation(s)
- Joseph Menczer
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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Luria O, Bar J, Kovo M, Malinger G, Golan A, Barnea O. The role of blood flow distribution in the regulation of cerebral oxygen availability in fetal growth restriction. Med Eng Phys 2011; 34:364-9. [PMID: 21871834 DOI: 10.1016/j.medengphy.2011.07.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 03/25/2011] [Revised: 07/26/2011] [Accepted: 07/28/2011] [Indexed: 11/18/2022]
Abstract
Fetal growth restriction (FGR) elicits hemodynamic compensatory mechanisms in the fetal circulation. These mechanisms are complex and their effect on the cerebral oxygen availability is not fully understood. To quantify the contribution of each compensatory mechanism to the fetal cerebral oxygen availability, a mathematical model of the fetal circulation was developed. The model was based on cardiac-output distribution in the fetal circulation. The compensatory mechanisms of FGR were simulated and their effects on cerebral oxygen availability were analyzed. The mathematical analysis included the effects of cerebral vasodilation, placental resistance to blood flow, degree of blood shunting by the ductus venosus and the effect of maternal-originated placental insufficiency. The model indicated a unimodal dependency between placental blood flow and cerebral oxygen availability. Optimal cerebral oxygen availability was achieved when the placental blood flow was mildly reduced compared to the normal flow. This optimal ratio was found to increase as the hypoxic state of FGR worsens. The model indicated that cerebral oxygen availability is increasingly dependent on the cardiac output distribution as the fetus gains weight.
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Affiliation(s)
- Oded Luria
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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Abstract
AIM To disclose potential risk factors for sustaining a fractured clavicle in the newborn. METHOD A retrospective case-control analysis of women who gave birth to an infant with a fractured clavicle during a four-year period (2003-2006) was performed. A control group of newborns who did not sustain a fractured clavicle was formed (2:1) matched for maternal age, parity and gestational age at delivery. RESULTS The rate of fractured clavicle was 0.35%. Heavier newborns' birth weight (3632.9 ± 376.1 g vs. 3429.5 ± 513.0 g, P < 0.05) and the use of oxytocin (91.3% vs. 69.5%, P < 0.05) were associated with the occurrence of fractured clavicle during birth. Fractured clavicle was not well correlated with maternal height, maternal pregestational body mass index, maternal body mass index at delivery, maternal weight gain during pregnancy, induction of labor, duration of the second stage of labor, instrumental delivery or newborn birth weight of more than 4000 g. CONCLUSION We could not identify significant risk factors that could be dealt with in order to avoid a fractured clavicle being sustained during birth. Most fractured clavicles occur in normal newborns following normal labor and delivery.
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Affiliation(s)
- Samuel Lurie
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
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Khazin V, Weitzman S, Rozenzvit-Podles E, Ezri T, Debby A, Golan A, Evron S. Postoperative analgesia with tramadol and indomethacin for diagnostic curettage and early termination of pregnancy. Int J Obstet Anesth 2011; 20:236-9. [DOI: 10.1016/j.ijoa.2011.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 11/24/2010] [Accepted: 03/05/2011] [Indexed: 10/18/2022]
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Kovo M, Schreiber L, Ben-Haroush A, Asalee L, Seadia S, Golan A, Bar J. The placental factor in spontaneous preterm labor with and without premature rupture of membranes. J Perinat Med 2011; 39:423-9. [PMID: 21526977 DOI: 10.1515/jpm.2011.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The association between infection and inflammatory response in preterm labor (PTL) is well established. Our aim was to elucidate the roles of utero-placental perfusion and fetal component, in PTL. METHODS Histopathologic findings in placentas from pregnancies complicated by preterm birth with or without premature rupture of membranes (ROM) (study group) were compared to placentas from pregnancies with delivery >34 weeks, with or without spontaneous ROM (control group). Placental lesions were classified as those consistent with maternal circulation abnormalities, maternal underperfusion, vascular or villous changes, and those consistent with fetal thrombo-occlusive disease, vascular or villous changes. Lesions were analyzed by maternal or fetal origin of inflammatory response. RESULTS The study group of 68 women, had a higher rate of vascular lesions than controls (136 women, 26.5% vs. 11%, P=0.005) and of inflammatory lesions of maternal and fetal origin (P<0.001). Within the study group, inflammatory lesions were more common in those with ruptured membrane than in those without (P<0.001). CONCLUSIONS Placentas from preterm birth demonstrate vascular lesions of maternal origin, in addition to the known inflammatory process. Preterm premature membrane rupture is associated with an increased rate of inflammatory lesions relative to spontaneous intact membranes-preterm birth, suggesting a different underlying mechanism.
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Affiliation(s)
- Michal Kovo
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel.
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Kovo M, Schreiber L, Ben-Haroush A, Klien H, Wand S, Golan A, Bar J. Association of non-reassuring fetal heart rate and fetal acidosis with placental histopathology. Placenta 2011; 32:450-3. [DOI: 10.1016/j.placenta.2011.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 02/14/2011] [Accepted: 03/10/2011] [Indexed: 12/01/2022]
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Sammar M, Nisemblat S, Fleischfarb Z, Golan A, Sadan O, Meiri H, Huppertz B, Gonen R. Placenta-bound and body fluid PP13 and its mRNA in normal pregnancy compared to preeclampsia, HELLP and preterm delivery. Placenta 2011; 32 Suppl:S30-6. [PMID: 21257080 DOI: 10.1016/j.placenta.2010.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 09/08/2010] [Accepted: 09/08/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare the distribution of placental protein 13 (PP13) in fetal and maternal blood and amnionic fluid and to correlate it with PP13 protein and mRNA in the placenta. METHODS Umbilical arterial serum, amnionic fluid, maternal venous serum and placental tissues were collected from normal outcome pregnancies (N = 63) (GA>37), early onset preeclampsia (PE) (N = 12, GA: 26-33), and HELLP syndrome (N = 5, GA: 27-29). Because PE and HELLP cases delivered preterm, cases of preterm delivery (PTD) (N = 6, GA: 31-36) served as additional control. PP13 was determined by ELISA, Western blot, and immunohistochemistry. PP13 mRNA was measured by PCR (RT-PCR). Continuous parameters were compared by t-test, P < 0.05 was considered significant. RESULTS In women with normal pregnancy outcome significantly higher PP13 levels were found in maternal serum compared to amnionic fluid and negligible amount was found in fetal serum. A similar pattern was identified in cases of PTD with concentrations similar to term control. In PE and HELLP cases PP13 levels in amnionic fluid level were more than twice compared to maternal serum (P < 0.001). Umbilical cord level was negligible in PE but high in HELLP corresponding to the much higher level of PP13 in this patient group compared to all others. In the placenta PP13 level in term controls was higher compared to PTD. In PE and HELLP (similar early delivery time as PTD) the level was significantly higher (P < 0.01) compared to PTD or term controls. PP13 mRNA levels in term control and PTD were similar while PP13 mRNA levels in PE and HELLP placentas were significantly lower compared to term controls or PTD or the two combined. Syncytiotrophoblast labeling appeared stronger in PE and HELLP compared to term controls and PTD. CONCLUSIONS In all cases but HELLP, PP13 in fetal blood is very low indicating that routing of PP13 to fetal blood is limited and that the fetus is unlikely to generate PP13. PP13 mRNA is lower in the third trimester at the time of disease while protein level accumulates and become higher creating an unparallel change in the level of the mRNA and the corresponding protein.
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Affiliation(s)
- M Sammar
- Diagnostic Technologies Ltd., Yoqneam, Israel.
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Ezri T, Lurie S, Weiniger CF, Golan A, Evron S. Cardiopulmonary resuscitation in the pregnant patient--an update. Isr Med Assoc J 2011; 13:306-310. [PMID: 21845974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Tiberiu Ezri
- Department of Anesthesia, Wolfson Medical Center, Holon, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Yedidia I, Ophir R, Yishay M, Ion A, Luzzatto T, Golan A, Burdman S. A STORY OF AN OLD BATTLE: PECTOBACTERIUM CAROTOVORUM AND ORNAMENTAL MONOCOTS. ACTA ACUST UNITED AC 2011. [DOI: 10.17660/actahortic.2011.886.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
OBJECTIVE The aim was to characterize the transfer of the insulin analog glargine across the placenta using the placental perfusion model. METHODS Placentas were obtained and selected cotyledons were cannulated and dually perfused. Glargine, 50 mU/L (n = 2) and 200 mU/L (n = 1), and a reference marker, antipyrine (50 μg/mL), were added to the maternal circulation. Samples were taken from the maternal and fetal compartments. RESULTS Glargine was not detected in the fetal compartment. In the maternal compartment, the steady state concentration was 50% lower than the starting concentration. CONCLUSIONS Glargine probably does not cross the human placenta. Reduced maternal steady state concentrations may suggest insulin uptake by the placenta.
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Affiliation(s)
- Michal Kovo
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv University, Israel. [corrected]
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Menczer J, Usviatzov I, Ben-Shem E, Golan A, Levy T. Reply: The role of neoadjuvant chemotherapy in ovarian cancer patients with extensive tumor burden. J Gynecol Oncol 2011. [DOI: 10.3802/jgo.2011.22.4.300] [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: 11/30/2022] Open
Affiliation(s)
- Joseph Menczer
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Irena Usviatzov
- Department of Rentgenology, E. Wolfson Medical Center, Holon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Erez Ben-Shem
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Abraham Golan
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tally Levy
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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Kovo M, Luria O, Golan A, Barnea O, Bar J. 427: Reactivity of placental blood vessels: differences between normal and growth-restricted placentas using the in-vitro dual perfused single cotyledon model. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Barda G, Ben-Haroush A, Barkat J, Malinger G, Luria O, Golan A, Bar J. Effect of vaginal progesterone, administered to prevent preterm birth, on impedance to blood flow in fetal and uterine circulation. Ultrasound Obstet Gynecol 2010; 36:743-748. [PMID: 20196070 DOI: 10.1002/uog.7606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the effect on the maternal and fetal circulation of progesterone administered to prevent preterm birth. METHODS We used an observational cohort study design. The study group included 44 women at 18-32 weeks' gestation who presented with an episode of preterm labor, with or without history of delivery before 34 weeks' gestation, or an incidental finding of short cervix (≤ 25 mm). Doppler flow assessment of the umbilical artery, fetal middle cerebral artery and uterine arteries was performed before and 24 h after vaginal administration of progesterone. RESULTS Seventeen (38.6%) women gave birth before term, but only nine (20.4%) did so before 34 weeks' gestation. Following progesterone treatment, there was a statistically significant decrease in the pulsatility index of the fetal middle cerebral artery (mean reduction, 18.2%; mean change in pulsatility index, 0.44 (95% CI, 0.25-0.63), P < 0.001), with no changes in the other vessels. Comparison of the women who gave birth before with those who delivered at term yielded no significant differences in Doppler flow parameters in any vessel examined, either before or after progesterone treatment. CONCLUSION Treatment with vaginal progesterone is associated with a lower pulsatility index in the fetal middle cerebral artery, suggesting a vasodilatory effect on the fetal circulation.
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Affiliation(s)
- G Barda
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
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