Oshri Barel

Clinical, sonographic, and epidemiologic features of second‐ and early third‐trimester spontaneous antepartum uterine rupture: a cohort study

To present prenatal findings and maternal and neonatal outcomes following second‐ and early third‐trimester spontaneous antepartum uterine rupture events in our institute.

Fetal abnormalities leading to third trimester abortion: nine‐year experience from a single medical center

To assess fetal abnormalities and events leading to third‐trimester abortion.

Hysteroscopic management of retained products of conception: meta-analysis and literature review

OBJECTIVE Hysteroscopic removal of retained products of conception (RPOC) may allow complete removal of RPOC and decreased rates of intrauterine adhesions (IUA) when compared to the traditional blind curettage. The aim of this meta-analysis is to examine the current evidence regarding the use of hysteroscopy for treatment of RPOC. STUDY DESIGN A literature search was conducted in December 2012 using MEDLINE and ClinicalTrials. The study selection criteria were use of the standard hysteroscopic technique for removal of RPOC in 5 or more cases, in any study design. We reviewed 11 studies, of which 5 retrospective studies met the selection criteria (comprising 326 cases). The rates of incomplete RPOC removal, surgical complications, post-operative IUA and subsequent pregnancies were abstracted and weighted events rates using a fixed meta-analysis model were calculated. RESULTS Only one study compared the rates of IUA following hysteroscopy and curettage, precluding a meta-analysis comparison of the two techniques. There were no cases of incomplete RPOC removal. Three perioperative complications occurred (uterine perforation, infection, and vaginal bleeding). IUA on follow-up hysteroscopy were found in 4/96 women (weighted rate of 5.7%, 95% CI 2.4%, 13.0%). Of the 120 women desiring a subsequent pregnancy 91 conceived (weighted rate of 75.3%, 95% CI 66.7%, 82.3%). CONCLUSIONS The lack of traditional curettage comparison groups in most studies precludes the conclusion that hysteroscopy is superior to traditional curettage, but this procedure does appear to have low complication rates, low rates of IUA, and high rates of subsequent pregnancies.

Termination of Pregnancy due to Fetal Abnormalities Performed after 23 Weeks’ Gestation: Analysis of Indications in 144 Cases from a Single Medical Center

Background/Aims: To assess the indications for late termination (≥23 weeks’ gestation) of pregnancy (LTOP), and to evaluate the rate of cases potentially diagnosable earlier. Methods: Cases of singleton pregnancy ending in LTOP due to fetal abnormalities in our institute between 1/1998 and 12/2005 were retrospectively reviewed. The women were divided into two groups according to the sequence of events that led to LTOP: Group 1 – the first test indicating an abnormal finding was performed ≤23 weeks’ gestation, but LTOP was performed >23 weeks; Group 2 – the first test indicating an abnormal finding was performed ≥23 weeks of gestation, or the fetal prognosis was not certain at the time of diagnosis and there was a medical recommendation to continue investigation. Results: There were 144 cases of LTOP (average gestational age 26.2 ± 3.4 weeks). More than 70% of the cases were aborted because of chromosomal/genetic indication in Group 1; many of them could have been detected earlier in pregnancy, while about 80% of the cases were aborted because of structural abnormalities in Group 2 (p < 0.001). The structural anomaly could have been diagnosed earlier in 56 cases (∼74%) if the pregnant woman had undergone an earlier anomaly scan. In another 13 cases (9%), fetal prognosis was not certain and continuing prenatal investigation was required. Conclusions: The most common indications for LTOP were structural abnormalities (91 cases, 70%) which included the central nervous system (26 cases, 29%), cardiac abnormalities (24 cases, 26%), and multiple malformations (18 cases, 20%). The diagnosis of fetal anomaly could have been made earlier in more than half of the pregnant women undergoing LTOP.

Sonographic fetal weight estimation – is there more to it than just fetal measurements?

The primary aim of this study was to evaluate the effects of different maternal, fetal, and examiner related factors on the accuracy of sonographic fetal weight estimation (SFWE).

Do assisted conception twins have an increased risk for anencephaly

BACKGROUND The incidence rates of anterior neural tube defects, anencephaly and encephalocele appear increased among twins compared with singletons. The current study aimed to evaluate whether the etiology of this phenomenon is related to twinning, assisted reproductive technology (ART), or both. METHODS The study cohort consisted of parturient women who were referred to our ultrasonography unit between January 1998 and December 2009 due to suspicion of severe fetal abnormality. The study cohort was divided into two subgroups based on mode of conception: spontaneous and ART (including IVF and ICSI). The subgroups were further subdivided into singleton and multiple pregnancies. We also compared pregnancies diagnosed with anencephaly in the study group to all live births in the Department of Obstetrics and Gynecology. RESULTS Anencephaly was diagnosed in 43 fetuses out of 1154 (3.7%) pregnancies diagnosed with severe fetal anomaly. Anencephaly was diagnosed in 9 out of 78 twin pregnancies (11.5%); of these, 8 of 45 (17.8%) were ART conceived and 1 of 33 (3%) spontaneously conceived. A significant correlation was found between twinning and anencephaly, with an odds ratio (OR) of 3.4 [confidence interval (CI) = 1.3-8.9, P= 0.011], while no significant correlation was found between ART and anencephaly. A significant correlation was found between anencephaly and the combination of ART conception and twinning (OR of 6.6, CI = 2.8-15.3, P< 0.01). Analyzing the distribution of pregnancies diagnosed with anencephaly in the study group compared with the total number of live births in the department revealed a significant correlation between twinning and anencephaly, with an OR of 11.4 (CI = 4.9-26.5, P< 0.01), with no significant correlation between ART and anencephaly. Among all live births, a significant correlation was found between anencephaly and the combination of ART conception and twinning (OR of 24.6, CI = 11.4-53.2, P< 0.01). CONCLUSIONS Our data suggest that twin pregnancies conceived by ART constitute a high-risk group for anencephaly, due to a possible synergistic effect of twinning and ART.

A search for the most accurate formula for sonographic weight estimation by fetal sex – a retrospective cohort study

The aim of this study was to assess the effect of fetal sex on the accuracy of multiple formulas for sonographic estimation fetal weight (SEFW).

Primary leiomyosarcoma of the omentum presenting as an ovarian carcinoma, case report and review of the literature

Primary omental leiomyosarcoma is a rare tumor. We report a case of successfully resected omental leiomyosarcoma whose presentation mimicked ovarian carcinoma. Symptoms of abdominal distension and discomfort that lasted 8 months followed by pain lead to a diagnosis of a large mass in the abdomen. Physical examination revealed a large, over 20 cm tumor, suspected to be of ovarian origin. A small amount of ascites was found on Computerized Tomography (CT) and ultrasound (US) scans. Total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy and tumor debulking procedure was planned. Laparotomy revealed normal uterus ovaries and tubes with a leiomyosarcoma of the omentum which was completely resected successfully. Only 26 cases of primary leiomyosarcoma of the omentum were previously described in the literature. A review of the literature is also presented.