Benny Almog

Adverse obstetric outcome for the vanishing twin syndrome

The aim was to compare obstetric outcomes of IVF singleton pregnancies diagnosed with vanishing twin (VT) syndrome with those pregnancies originating as singleton pregnancies and with twin pregnancies. In this case control study, 57 patients diagnosed with VT syndrome were matched and compared with 171 singleton controls and 171 twin controls. Mean gestational age was 35.1+/-3.7 versus 38.2+/-2.6 weeks (P=0.001) for patients and singleton controls respectively. Birth weights were 2834.4+/-821.2 versus 3036+/-489.3g (P=0.02), proportion of low birth weight (< 2500 g) was 33.3 versus 11.7% (P=0.0001) and very low birth weight (< 1500 g) 3.5 versus 0.6% for patients and singleton controls respectively. The proportion of deliveries before 28 weeks of gestation was 7.0 versus 1.2% (P=0.01) for patients and singleton controls respectively. When comparing the study group to twin control pregnancies, a similar gestational age at delivery (35 weeks) and rate of preterm birth (23%) were found. In conclusion, pregnancies diagnosed with the VT syndrome after IVF carry a higher rate of adverse obstetric outcomes in terms of preterm deliveries and lower birth weight, compared with IVF pregnancies that were originally singleton. Additionally, significant similarities were observed in the obstetrics outcome of vanishing twin pregnancies and twin pregnancies.

Risk factors for relaparotomy after cesarean delivery

To identify risk factors for relaparotomy after cesarean delivery.

The resistance index in the fetal middle cerebral artery by gestational age and ventricle size in a normal population.

OBJECTIVE To study the association between fetal middle cerebral artery flow and the lateral cerebral ventricular width throughout gestation. METHODS The study is a prospective cohort evaluation of 430 singleton male and female fetuses between 20 and 40 weeks normal gestation. Abdominal ultrasonography and Doppler measurements were performed to measure the fetal atrial ventricular size and resistance index (RI) of the middle cerebral artery. RESULTS The mean (± standard deviation) ventricular width was 6.2 ± 1.2 mm. The modification in the RI of the middle cerebral artery throughout gestation showed a biphasic mode, increasing gradually to a peak at 30 weeks gestation and decreasing progressively thereafter. No significant correlation was found between the middle cerebral artery flow and the lateral cerebral ventricular width (r = .11). In addition to the 430 cases studied, three cases of mild ventriculomegaly and three cases of hydrocephalus were evaluated. The RI of the middle cerebral artery was within the normal range in all six of these cases. CONCLUSION Fetal middle cerebral artery blood flow is not affected by the width of the lateral ventricles, even in enlarged ventricles.

Clinical Estimation of Fetal Weight: Is Accuracy Acquired with Professional Experience?

Objective: This study was conducted in order to determine whether experience and type of obstetrical profession improves the accuracy in the clinical estimation of fetal weight among obstetricians and midwives in the delivery room. Methods: Four groups of professionals in the delivery room clinically estimated the fetal weight in 236 parturients in active labor. Obstetric parameters such as gravidity, parity, gestational age, body mass index, amniotomy, station and cervical dilatation were recorded. Fetal weight estimations were compared with the actual birth weight after delivery. Results: The mean error rate of fetal weight estimation by attending obstetricians, residents, experienced and junior midwives was 7.9 ± 8.8, 8.0 ± 8.4, 7.8 ± 6.3 and 8.5 ± 6.8%, respectively. Error rates of the 4 groups of examiners were similar, although it was increased in all subgroups when estimating birth weights <2,500 and >4,000 g. Major discrepancies of fetal weight estimation (>10% of the actual fetal birth weight) occurred in 27.2, 28.9, 31.9 and 34.7% by attending obstetricians, residents, experienced and junior midwives, respectively. Conclusions: We found no additional value for experience and type of obstetrical training in the accuracy of clinical fetal weight estimation.

Prediction of cervical involvement in endometrial cancer by hysteroscopy

AbstractObjectiveThis study evaluated the ability of hysteroscopy to preoperatively predict cervical involvement in endometrial cancer.MethodsThe records of 110 surgically staged consecutive endometrial cancer patients treated at our institution from 1997 to 2003 were retrospectively analyzed. Data on demographics, preoperative staging procedures, surgical pathology reports, and adjuvant treatments were retrieved.ResultsFourteen (12.7%) patients had cervical involvement (stage II) according to the surgical pathology report, of whom nine (8.1%) had stage IIA and five (4.6%) had stage IIB. Clinical evaluation by speculoscopy and palpation had failed to reveal any indication of cervical involvement. Preoperative diagnostic hysteroscopy procedures were included. None of the hysteroscopy procedures revealed any suspicious lesion in the cervical canal.nConclusionHysteroscopy and clinical examination fail to adequately predict cervical involvement in endometrial carcinoma. Fractional D&C appears to be the best method until a more effective alternative becomes available.

Ultrasonography in Controlled Ovarian Stimulation

The field of infertility and reproductive endocrinology relies heavily on imaging. Of all imaging modalities, ultrasonography has emerged as the key modality in artificial reproductive technologies. Its role begins with assisting in the diagnosis of the cause of infertility, through deciding on the optimal treatment strategy, execution of personalized fertility treatments and diagnosis and treatment of potential complications arising during treatment. This chapter provides an evidence-based review of the role of ultrasound in COS. Prior to the initiation of treatment, ultrasound assists in pelvic evaluation (predicting treatment success, assuring a dominant follicle has not emerged and diagnosing ovarian abnormalities that should be addressed). After designing the personalized treatment protocol, ultrasound is fundamental in monitoring the response to treatment (endometrial and ovarian follicular response). In in vitro fertilizations it has a key role in guiding embryo transfer. Lastly, its role does not end with achieving pregnancy but is also essential in the diagnosis and treatment of COS complications (abdominal haemorrhage, pelvic infections, adnexal torsion, ectopic pregnancy and ovarian hyperstimulation syndrome). In fact, so indispensible is its use that it would be almost impossible to imagine COS achieved successfully and safely without pelvic ultrasonography.

Compliance with Methotrexate Treatment for Ectopic Pregnancy

One of the criteria of medical treatment of methotrexate is good patient compliance. It appears that underprivileged inner-city populations do not comply with methotrexate treatment satisfactorily. Due to the risk of tubal rupture, women with poor compliance should be treated surgically. Approximately one in four women will experience tubal rupture. Accordingly, careful assessment regarding the patients’ ability to comply with treatment protocol before deciding on the treatment should be performed.

Contents Vol. 32, 2012

R. Achiron, Tel Hashomer N.S. Adzick, Philadelphia, Pa. L. Allan, London A.A. Baschat, Baltimore, Md. K.J. Blakemore, Baltimore, Md. T.-H. Bui, Stockholm F.A. Chervenak, New York, N.Y. T. Chiba, Tokyo R. Chmait, Los Angeles, Calif. F. Crispi, Barcelona J.E. De Lia, Milwaukee, Wisc. J.A. Deprest, Leuven G.C. Di Renzo, Perugia J.W. Dudenhausen, Berlin N.M. Fisk, Brisbane, Qld. A.W. Flake, Philadelphia, Pa. U. Gembruch, Bonn M.R. Harrison, San Francisco, Calif. J.C. Hobbins, Denver, Colo. L.K. Hornberger, San Francisco, Calif. E.R.M. Jauniaux, London M.P. Johnson, Philadelphia, Pa. C. Jorgensen, Copenhagen J.-M. Jouannic, Paris P.M. Kyle, London O. Lapaire, Basel S. Lipitz, Tel-Hashomer G. Malinger, Holon G. Mari, Detroit, Mich. M. Martinez-Ferro, Buenos Aires K.J. Moise, Houston, Tex. F. Molina, Granada K.H. Nicolaides, London D. Oepkes, Leiden L. Otaño, Buenos Aires Z. Papp, Budapest R.A. Quintero, Miami, Fla. G. Ryan, Toronto J. Rychik, Philadelphia, Pa. H. Sago, Tokyo W. Sepulveda, Santiago P. Stone, Auckland D.V. Surbek, Bern B.J. Trudinger, Westmead, N.S.W. J.M.G. van Vugt, Amsterdam Y. Ville, Paris Clinical Advances and Basic Research