David Yohay

Fetal heart rate monitoring category 3 during the 2nd stage of labor is an independent predictor of fetal acidosis.

Abstract Objective: To determine whether fetal heart rate (FHR) monitoring categories during the 1st and 2nd stage of labor can predict arterial cord pH <7.2. Materials and methods: A case control study was conducted including 653 consecutive term deliveries (37 weeks gestation and above) that were divided according to fetal pH ≤ 7.2 (n = 315) and fetal pH > 7.2 (n = 338). Deliveries occurred during the year 2013 in tertiary medical center, where arterial cord pH is routinely taken after birth. Intrapartum FHR monitoring categorization was defined according to the ACOG committee guidelines by two obstetricians. Multivariable models were constructed to control for confounders. Results: Variable decelerations, late decelerations and bradycardia during the 1st and 2nd stages of labor were significantly higher in group of deliveries ended in cord pH < 7.2 compared with group of deliveries ended in cord pH > 7.2. A significant association was observed between category 2 and 3 during the 1st stage of labor and pH ≤ 7.2. However, while controlling for FHR category 3 at the 2nd stage of labor, 1st stage categorization lost its association with pH <7.2, and only category 3 during the 2nd stage were noted as an independent risk factor for acidosis. Conclusion: FHR monitoring category 3 during the 2nd stage of labor is an independent predictor of fetal acidosis as expressed by arterial cord pH < 7.2.

Native tissue repair for central compartment prolapse: a narrative review.

Central descent due to a level 1 defect is a main component in pelvic organ prolapse (POP) reconstructive surgery, whether for symptomatic apical prolapse or for the prolapse repair of other compartments. A recent growth in the rate of native tissue repair procedures for POP, following the US Food and Drug Administration (FDA) warnings regarding the safety and efficacy of synthetic meshes, requires a re-evaluation of these procedures. The safety, efficacy, and determination of the optimal surgical approach should be the center of attention. Functional outcome measures and patient-centered results have lately gained importance and received focus. A comprehensive literature review was performed to evaluate objective and subjective outcomes of apical prolapse native tissue repair, with a special focus on studies reporting impact on patients’ functional outcomes, quality of life, and satisfaction. We performed a MEDLINE search for articles in the English language by using the following key words: apical prolapse, sacrospinous ligament fixation, uterosacral ligament suspension, sacral colpopexy, McCall culdoplasty, iliococcygeus vaginal fixation, and functional outcomes. We reviewed references as well. Despite a prominent shortage of studies reporting standardized prospective outcomes for native tissue repair interventions, we noted a high rate of safety and efficacy, with a low complication rate for most procedures and low recurrence or re-treatment rates. The objective and subjective results of different procedures are reviewed. Functional outcomes of native tissue repair procedures have not been studied sufficiently, though existing data present those procedures as favorable and not categorically inferior to sacrocolpopexy. Apical compartment prolapse repair using native tissue is not a compromise. Functional outcomes of native tissue repair procedures are favorable, have a high rate of success, improve women’s quality of life (QoL), and result in high rates of patient satisfaction. This subject requires further long-term, standardized prospective studies following the International Continence Society/International Urogynecologists Association guidelines for surgical outcomes report, with the focus on patient-centered functional outcomes.

IL‐1 Activity is Expressed Differently During Pregnancy in the Rat Uterine Artery than in Aortic or Uterine Tissues

PROBLEM: Uterine artery was shown to be unique in its capacity to change in size and function during pregnancy. As interleukin‐1 (IL‐1) was shown to be involved in reproduction processes, the aim of this study was to determine the levels of IL‐1 activity of the uterine artery tissue in pregnant rat.

Association between hypertensive disorders of pregnancy and third stage of labor placental complications

OBJECTIVE To examine the association between hypertensive disorders of pregnancy and third stage placental complications. METHODS A retrospective cohort study based on Soroka Medical Center institutional computerized database. All vaginal deliveries of women between the years 1998-2013 were included. Rates of third placental complications and other adverse pregnancy outcomes were compared between parturients with and without hypertensive disorders of pregnancy. Multivariate analysis models as well as generalized equations models (GEE) controlling for potential confounders were constructed. RESULTS Of 263,053 deliveries included, 14,754 (5.6%) were complicated by hypertensive disorders of pregnancy. Hypertensive parturients were older, had higher rates of: diabetes, previous cesarean section and induction of labor. Rates of third stage placental complications were significantly higher among hypertensive parturients (4.7% versus 4.0%, p value <0.001). Preeclampsia was found independently associated with third placental complication in the logistic regression and the GEE models constructed. Adjusted odds ratio, 95% confidence interval, respectively: 1.11 (1.00-1.24); 1.11 (1.00-1.25). CONCLUSION Our study was the first to demonstrate that an association between hypertensive disorders of pregnancy and third stage placental complications exists, suggesting a common pathological pathway. Further larger studies are needed in order to reinforce these findings.

Effectiveness and safety of late midtrimester cervical cerclage

Abstract Objectives: To evaluate the safety and effectiveness of late cervical cerclage performed beyond 17 weeks of gestation. The outcomes of interest were effectiveness of late cerclage in prolongation of pregnancy and evaluation of pregnancy outcome including maternal and fetal complications. Study design: A total of 30 patients underwent late cervical cerclage during the study period. Of them, two were twin pregnancies. A late cerclage was performed after the diagnosis of cervical shortening or dilatation in 20 patients. We performed a retrospective case series review. One case was lost to follow up (delivery in another medical center). Medical information was retrieved from all cases of patients who underwent a late cervical cerclage between the years 2010 and 2016 at the Soroka University Medical Center, a tertiary medical center. Continuous variables were expressed as mean ± standard deviation. Categorical variables were expressed as proportions. Results: The average gestational age at birth was 35 ± 5.1 weeks of gestation. The mean interval between cerclage and delivery in the study population was 17 ± 5.62 weeks. Nine cases (32.1%) resulted in preterm deliveries, three of them below 34 weeks of gestation (one twin pregnancy and two pregnancies diagnosed with cervical dilation prior to cerclage). Among all the preterm deliveries, there were four cases of preterm prelabor rupture of membranes (13.3%). Of the 28 deliveries, 24 women (85.7%) had a vaginal delivery, while four women (14.3%) underwent a cesarean section. No cases of cervical tear were described. The cerclage was sent to bacteriology after removal, showing positive cultures for Candida species in nine cases (31%). Conclusions: In our study population, late cervical cerclage was found to be a safe procedure resulting in almost 90% of successful vaginal deliveries without maternal or fetal complications. This procedure might be effective in the prolongation of pregnancy in women with cervical dynamics in the late second trimester.

Risk factors for obstetric anal sphincter injuries (OASIS) during vacuum extraction delivery in a university affiliated maternity hospital

Abstract Introduction: Instrumental delivery is a well-known risk factor for obstetric anal sphincter injuries (OASIS). The specific characteristics among patient undergoing vacuum extraction delivery (VE) are less studied. Therefore, we aimed to evaluate risk factors for OASIS among parturient that underwent a VE delivery in a large university affiliated maternity hospital. Material and methods: The study population contained 9116 women who delivered by VE in tertiary medical center from 1988 to 2015. Inclusion criteria included deliveries beyond 24-week gestation. Multiple gestations and pregnancies complicated with stillbirth were excluded from the analysis. Maternal obstetric variables were compared between parturient with and without OASIS. Independent risk factors for OASIS were assessed by multivariable logistic regression modeling. Results: OASIS was diagnosed in 94 women (1.03%) following vacuum extraction. Among patients who underwent a VE delivery, gravidity and parity were found to be significantly lower in patients with OASIS. A multivariable logistic regression model with OASIS as the outcome variable revealed that among women who underwent VE, while episiotomy and delivery of a macrosomic neonate were not independently associated with OASIS, a strong association between nulliparity and OASIS was found (OR 3.34; 95% CI 1.93–5.78; p < .001). Conclusions: OASIS is uncommon in our population. Vacuum extraction in nulliparous parturient is a significant risk factor for OASIS. Our results should be taken into account when managing nulliparous deliveries.

Prevalence and risk factors for urinary tract infection following stress urinary incontinence surgery with two midurethral sling procedures

To compare prevalence and risk factors for urinary tract infection (UTI) following midurethral sling surgery with either the GYNECARE ABBREVO Continence System (Ethicon, Somerville, NJ, USA) or a standard transobturator.

Comparative analysis of early adverse events of pelvic organ prolapse repair with or without transvaginal mesh using Clavien‐Dindo classification

To assess adverse events following surgical repair of pelvic organ prolapse (POP) with or without the use of transvaginal mesh.