Efrat Spiegel

Risk factors predicting an emergency cesarean delivery for the second twin after vaginal delivery of the first twin

ObjectiveTo investigate obstetrical risk factors predicting failure of vaginal delivery and an emergency cesarean section (CS) for the second twin after vaginal delivery of the first twin. In addition, the study was aimed to define perinatal outcomes of the second twin.Study designA retrospective study was conducted, comparing all deliveries of twins in which CS was performed for the second twin to those in which both twins were delivered vaginally during the years 1988–2010. Women with multiple gestations in which a CS was performed for both twins were excluded from the study.ResultsDuring the study period, 1966 vaginal deliveries of the first twin were recorded; 192 involved emergency CS for the second twin. Risk factors for emergency CS of the second twin were preterm delivery, previous CS, placental abruption and breech presentation of the second twin. Perinatal outcomes did not differ between the groups.ConclusionRisk factors for emergency cesarean section of the second twin are preterm delivery, previous CS, placental abruption and breech presentation. Nevertheless, short-term perinatal outcomes are comparable to twins delivered vaginally.

The use of sonographic cervical length assessment for the prediction of time from induction to delivery

Abstract Objective: The objective of this study is to investigate the role of trans-vaginal cervical length measurement in the prediction of the interval to successful vaginal delivery after induction of labor with balloon catheter. Methods: In this prospective study of cervical length measurement before induction of labor, singleton pregnancies that underwent induction of labor between 37 and 42 weeks of gestation were included. The data collected included trans-vaginal sonographic cervical measurements followed by digital cervical assessment. Bishop score was used to quantify digital assessment (before induction of labor). Results: During the study period, 71 patients were included in the study. A statistically significant linear correlation was found between sonographic cervical length prior to induction of labor and the time of delivery (Pearson correlation 0.335; p values 0.005). Of the 57 vaginal deliveries, 27 patients had a cervical length of less than 28 mm. Patients with a cervical length of less than 28 mm had a significantly shorter time to delivery compared to patients with more than 28 mm length (20.4 versus 28.7, respectively; p value = 0.019). Cervical length of 28 mm remained significantly correlated even after performing several logistic regression models in order to control for confounders such as parity and age. In addition, a correlation was found between Bishop scores of above 7 to the time to delivery. Conclusions: Cervical length is correlated linearly to the time interval between induction of labor and delivery. A cervical length of less than 28 mm was found to be statistically significant in predicting a shorter time to delivery.

Maternal gestational diabetes mellitus: is it associated with long-term pediatric ophthalmic morbidity of the offspring?

Abstract Purpose: To determine whether children born to mothers with gestational diabetes mellitus (GDM) are at increased risk to develop of pediatric ophthalmic morbidity. Materials and methods: In this population based cohort study, all deliveries between 1991 and 2014 were included. Congenital malformations, multiple gestations, and patients lacking prenatal care were excluded from analysis. Mothers were defined as either having no GDM, having diet-treated GDM, or medically treated GDM. Outcomes were defined as different ophthalmic morbidities of the offspring until the age of 18. Kaplan–Meier curves were used to compare the cumulative morbidity in each group, and a Cox proportional hazard model was used to control for possible confounders. Results: During the study period, 238,622 deliveries met the inclusion criteria, of those 4.0% (n = 9601) of mothers were diagnosed with GDM treated by diet, and an additional 1.0% (n = 2398) were diagnosed with GDM treated by medication. Offsprings of patients with GDM treated by medication had a higher cumulative incidence of ophthalmic morbidity when compared to the other groups (Kaplan–Meier log rank test p = .038). GDM treated by medication was found to be an independent risk factor for long-term ophthalmic morbidity, in a cox multivariable model (adjusted HR: 1.5, 95%CI: 1.05–2.1, p = .025). Conclusions: Gestational diabetes mellitus treated by medication is associated with an increased risk for long-term pediatric ophthalmic morbidity.

The association between birth weight at term and long-term endocrine morbidity of the offspring

Abstract Objective: To investigate whether small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth weight at-term poses an increased risk for long-term pediatric endocrine morbidity. Study design: A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to endocrine morbidity of singleton children born SGA, appropriate-for-gestational-age (AGA), and LGA at-term. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders. Results: During the study period, 235,614 deliveries met the inclusion criteria; of which 4.7% were SGA (n = 11,062), 91% were AGA (n = 214,249), and 4.3% were LGA neonates (n = 10,303). During the follow-up period, children born SGA or LGA at-term had a significantly higher rate of long-term endocrine morbidity. Using a multivariable GEE logistic regression model, controlling for confounders, being delivered SGA or LGA at-term was found to be an independent risk factor for long-term pediatric endocrine morbidity (Adjusted OR = 1.4; 95%CI = 1.1–1.8; p = .015 and aOR = 1.4; 95%CI = 1.1–1.8; p = .005, respectively). Specifically, LGA was found an independent risk factor for overweight and obesity (aOR = 1.7; 95%CI = 1.2–2.5; p = .001), while SGA was found an independent risk factor for childhood hypothyroidism (aOR = 3.2; 95%CI = 1.8–5.8; p = .001). Conclusions: Birth weight either SGA or LGA at-term is an independent risk factor for long-term pediatric endocrine morbidity.

Prenatal exposure to preeclampsia as an independent risk factor for long-term cardiovascular morbidity of the offspring

INTRODUCTION Preeclampsia is a leading cause of maternal and fetal morbidity and mortality. Regarding the offspring, little is known about the long-term complications. The objective of the current study is to assess whether in utero exposure to preeclampsia increases the risk of long-term cardiovascular morbidity in the offspring. MATERIALS AND METHODS A population-based cohort study compared the incidence of cardiovascular disease between singletons exposed and unexposed to preeclampsia. Deliveries occurred between 1991 and 2014 in a regional tertiary medical center. A Cox proportional hazard model was used to control for confounders. RESULTS During the study period 231,298 deliveries met the inclusion criteria; 4.1% of the births were to mothers diagnosed with preeclampsia, of which 3.2% with mild preeclampsia (n = 7286), 0.9% with severe preeclampsia (n = 2174) and 0.03% with eclampsia (n = 73). A significant linear association was noted between preeclampsia (no preeclampsia, mild preeclampsia, severe preeclampsia and eclampsia) and cardiovascular disease of the offspring (0.24%, vs. 0.33% vs. 0.51% vs. 2.73% respectively, p < 0.001 using the chi-square test for trends). In the offspring born at term, severe preeclampsia was found to be an independent risk factor for cardiovascular morbidity (adjusted HR = 2.32; 95% CI 1.15-4.67). In offspring born preterm, neither severe preeclampsia (adjusted HR = 1.36; 95% CI 0.53-3.48) nor mild preeclampsia (adjusted HR = 0.37; 95% CI 0.52-2.71) were associated with cardiovascular morbidity of the offspring. CONCLUSION Exposure to severe maternal preeclampsia is an independent risk factor for long-term cardiovascular morbidity in the offspring born at term.

Maternal Asthma Is an Independent Risk Factor for Long-Term Respiratory Morbidity of the Offspring

Objective The objective of this study was to investigate whether maternal bronchial asthma increases the risk for long‐term respiratory morbidity of the offspring. Study Design A population‐based cohort study compared the incidence of long‐term pediatric hospitalizations due to respiratory disease of the offspring of mothers with and without bronchial asthma. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. Congenital malformations as well as multiple pregnancies were excluded. Kaplan‐Meiers survival curve was used to estimate cumulative incidence of respiratory morbidity. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders. Results During the study period, 253,808 deliveries met the inclusion criteria; of which 1.3% were born to mothers with bronchial asthma (n = 3,411). During the follow‐up period, children born to women with bronchial asthma had a significantly higher rate of long‐term respiratory morbidity (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.3‐1.7; p < 0.001). Specifically, the rate of childhood asthma was higher among offspring of mothers with asthma (OR = 2.3; 95% CI = 1.8‐2.9; p < 0.001). Children born to women with asthma had higher cumulative incidence of respiratory morbidity, using a Kaplan‐Meiers survival curve (log‐rank test; p < 0.001). Using two multivariable GEE logistic regression models, controlling for the time to event, maternal age, and gestational age at delivery, maternal bronchial asthma was found to be an independent risk factor for long‐term respiratory disease of the offspring (adjusted OR = 1.6; 95% CI = 1.4‐1.9; p < 0.001), and specifically for bronchial asthma (adjusted OR = 2.5; 95% CI = 1.9‐3.1; p < 0.001). Conclusion Maternal bronchial asthma is an independent risk factor for long‐term respiratory morbidity of the offspring.