Rinat Gabbay-Benziv

Fibroblast growth factor 10 in human ovaries

The expression of fibroblast growth factor 10 (FGF-10) has not been studied in human ovarian cortical follicles. The aim of the present study was to investigate the expression of FGF-10 in preantral follicles from fetuses, girls and women. Ovarian samples were obtained from 14 human fetuses at 21-33 gestational weeks and from 35 girls and women aged 5-39 years. The specimens were prepared for detection of the FGF-10 protein by immunohistochemistry. Reverse-transcription PCR was applied to ovarian extracts to identify FGF-10 mRNA transcripts. In fetal tissue, the FGF-10 protein was detected in oocytes in 50% of the samples and in granulosa cells in 30%. In ovarian tissue from girls and women, the FGF-10 protein was detected in oocytes and granulosa cells in all samples. FGF-10 mRNA transcripts were present in all adult and fetal samples tested. The identification of FGF-10 at both the protein and mRNA levels suggests that FGF-10 may contribute to human preantral follicle development.

Obstetric antiphospholipid syndrome and long term arterial thrombosis risk

Antiphospholipid syndrome (APS) is classified as the association of a thrombotic event and/or obstetric morbidity in patients persistently positive for antiphospholipid antibodies and/or lupus anticoagulant. To evaluate the incidence of subsequent thrombosis among women diagnosed with purely obstetric APS. We retrospectively reviewed and collected demographic and clinical data from the computerized charts of all patients with obstetric APS, from 1992 to 2017. Eligibility criteria included all women diagnosed with APS, according to the 2006 revised criteria, for whom the clinical manifestations were purely obstetric. The primary endpoint was the occurrence of subsequent thromboembolic events, following diagnosis of obstetric APS. The study included 115 women diagnosed with obstetric APS. During the study’s follow up period, 12 (10.4%) women developed thrombosis. Of the 12 women who developed thrombosis, 9 (75%) of the thrombotic events were arterial. The site of arterial thrombosis was cerebral in all cases. Venous thrombosis occurred in 3 (25%) women, including one in each of the following sites—pulmonary embolism, ovarian vein thrombosis and proximal leg deep vein thrombosis. Our data suggests that women with obstetric APS are at risk for subsequent long-term thrombosis, especially arterial cerebral events. We did not identify any clinical or laboratory unique features among women with obstetric APS who will eventually develop thrombosis.

Induction of labor: does indication matter?

PurposeLabor induction is performed in 20xa0% of pregnancies. However, the impact of the indications for induction on its failure rate has hardly been investigated. We aimed to evaluate the association of indications for labor induction with failure rate.MethodsBackground and delivery-related data were retrospectively collected for all women with a viable term singleton pregnancy, who underwent labor induction with a PGE2 vaginal insert in 2013–2014. Reasons for induction were categorized as maternal indications, hypertensive disorders, premature rupture of membranes, and fetal indications. Induction failure was defined as Bishop score ≤7 at 24xa0h after PGE2 administration, cesarean delivery due to latent phase dystocia or removal of the insert due to non-reassuring fetal heart rate followed by emergency cesarean delivery. Outcome measures were rate of induction failure (primary) and rate of cesarean delivery (secondary).ResultsThe cohort included 1066 women. Those who failed induction (nxa0=xa0213, 20xa0%) were more likely to be nulliparous (69.5 vs. 45.7xa0%, pxa0<xa00.0001), older (31 vs. 30xa0years, pxa0=xa00.047), and at an earlier gestational age (39.4 vs. 40.0xa0weeks, pxa0<xa00.0001). Among nulliparous women, maternal indications were significantly associated with induction failure (aOR 2.52, 95xa0% CI 1.28–4.95, pxa0=xa00.007) and cesarean delivery (aOR 2.36, 95xa0% CI 0.40–2.29, pxa0=xa00.019). Among multiparous women, hypertensive disorders (aOR 7.26, 95xa0% CI 1.89–27.87, pxa0=xa00.004) and maternal indications (aOR 4.22, 95xa0%CI 1.14–15.58, pxa0=xa00.031) were significantly associated with induction failure but not cesarean delivery.ConclusionsThe indication for induction of labor may impact its failure rate.

Predictive value of cervical length in women with twin pregnancy presenting with threatened preterm labor

To assess the accuracy and determine the optimal threshold of sonographic cervical length (CL) for the prediction of preterm delivery (PTD) in women with twin pregnancies presenting with threatened preterm labor (PTL).

Symptomatic congenital cytomegalovirus disease following non-primary maternal infection: a retrospective cohort study

BackgroundScarce data exist about screening, diagnosis and prognosis of non-primary Cytomegalovirus (CMV) during pregnancy. We aimed to examine antenatal diagnosis of maternal non-primary CMV infection and to identify risk factors for congenial CMV disease.MethodsRetrospective cohort of 107 neonates with congenital symptomatic CMV infection, following either primary (nu2009=u200995) or non-primary (nu2009=u200912) maternal CMV infection. We compared the groups for the manifestations and severity of congenial CMV disease, as well as for possible factors associated with the risk of developing CMV related infant morbidity.ResultsDisease severity is not similar in affected newborns, with a higher incidence of abnormal brain sonographic findings, following primary versus non-primary maternal CMV infection (76.8% vs. 8.3%, pu2009<u2009.001). Symptomatic congenital CMV disease following a non-primary infection is more frequent if gestational hypertensive disorders and/or gestational diabetes mellitus have ensued during pregnancy (33.3% vs. 9.9%, pu2009<0.038), as well as if any medications were taken throughout gestation (50% vs. 16.8%, pu2009<0.016). CMV-IgM demonstrates a low detection rate for non-primary maternal infection during pregnancy compared to primary infection (25% vs. 75.8%, pu2009=u20090.0008).ConclusionNon-primary maternal CMV infection has an impact on the neonate. Although not readily diagnosed during pregnancy, knowledge of risk factors may aid in raising clinical suspicion.

Can we predict successful cervical ripening with prostaglandin E2 vaginal inserts

PurposePrevious studies have suggested that a variety of maternal and obstetrical characteristics may predict successful prostaglandin E2 (PGE2) cervical ripening. However, in most studies women were administered vaginal tablets or gel so scarce is known regarding potential predictors in women administrated slow-release vaginal inserts. We aimed to characterize the response of cervical ripening for labor induction using slow-release PGE2 vaginal insert and to identify predictors for success.MethodsA retrospective cohort study in a single center (2013–2015). The association between maternal characteristics at admission and cervical ripening success/failure were explored. Cervical ripening failure was defined as a Bishop’s score <7 following 24xa0h from cervical ripening or the need for cesarean delivery (CS) due to arrest of dilatation at cervical dilatation ≤5xa0cm. Cases with major fetal anomalies, multiple gestations, non-vertex presentation or any contraindication for vaginal delivery were excluded.ResultsOf 15,564 deliveries during the study period, 986 (6.3%) women met inclusion criteria, of them, 774 (78.56%) succeeded and 212 (21.5%) failed cervical ripening. Cervical ripening success was associated with (OR, 95% CI): nulliparity (0.42, 0.22–0.81, pxa0=xa00.009, i.e., nulliparity was negatively associated with successful ripening), gestational age (GA) at delivery (1.29, 1.02–1.61, pxa0<xa00.03), and cervical dilation at admission (4.58, 2.57–8.17, pxa0<xa00.001). The indications for labor induction were not associated with cervical ripening success. A prediction model which included the abovementioned characteristics had an AUC of 0.792 (95% CI 0.743–0.840).ConclusionsOverall, basic parameters, such as parity, cervical dilatation at admission and gestational age can predict successful cervical ripening PGE2 vaginal inserts.

Meconium-Stained Amniotic Fluid and Neonatal Morbidity in Low-Risk Pregnancies at Term: The Effect of Gestational Age

Objective To assess the association of gestational age at delivery with perinatal outcome in low‐risk term deliveries complicated by meconium‐stained amniotic fluid (MSAF). Methods We retrospectively analyzed all singleton deliveries that underwent a trial of labor in a single hospital (2007‐2013). Exclusion criteria included pregnancy‐related complications (e.g., hypertensive disorders, diabetes, oligohydramnios, and fetal anomalies). First, only deliveries with MSAF were analyzed. Perinatal outcome of deliveries at 370/7 to 386/7 weeks (early term) and 410/7 to 416/7 weeks (late term) were compared with those at 390/7 to 406/7 weeks of gestation (full term). Additionally, a gestational age based comparison was made between the risk for neonatal respiratory morbidity in deliveries with clear amniotic fluid and MSAF. Results During the study period, 28,248 deliveries were considered as low risk. Of them, 3,399 (12.0%) were diagnosed with MSAF and were divided to full term (n = 2,413), early term (n = 405), and late term (n = 581). In multivariate analysis, MSAF at early term was associated with neonatal jaundice, need for phototherapy, and neonatal sepsis. In a gestational age based stratification, when comparing between deliveries with clear amniotic fluid and those with MSAF, late term had the highest odds (4.2 vs. 0.5%; p < 0.001) for neonatal respiratory morbidity. Conclusion Gestational age was associated with specific complications in deliveries complicated by MSAF and otherwise low‐risk deliveries.

Adverse neonatal and maternal outcome following vacuum-assisted vaginal delivery: does indication matter?

PurposeTo estimate the impact of indication for vacuum-assisted vaginal delivery on neonatal and maternal adverse outcome.MethodsRetrospective analysis of women carrying singleton-term pregnancies undergoing vacuum-assisted vaginal delivery in a tertiary hospital (2007–2014). Cohort was stratified by indication: non-reassuring fetal heart rate or prolonged second stage. Primary outcome was adverse neonatal outcome and secondary outcome was maternal morbidity. Logistic regression analysis was utilized to adjust for potential confounders.ResultOverall, 4931 women met inclusion criteria. Delivery indication was prolonged second stage in 3143 (64%) cases and non-reassuring fetal heart rate in 1788 (36%). In the non-reassuring fetal heart rate group, there were higher rates of cephalohematoma, low 5-min Apgar-score, and asphyxia. In the prolonged second-stage group, there were higher rates of sepsis and post-partum hemorrhage. Composite neonatal birth trauma and maternal morbidity were higher for vacuum-assisted vaginal delivery following prolonged second stage. Following adjustment for confounders cephalohematoma (aOR 1.21, 95% CI 1.04–1.41), low 5-min Apgar-score (aOR 2.91, 95% CI 1.26–4.67) and asphyxia (aOR 1.81 95% CI 1.35–2.44) remained significant in the non-reassuring fetal heart rate group and neonatal sepsis remained significant for the prolonged second-stage group (aOR 1.77, 95% CI 1.38–2.27), pu2009<u20090.05 for all. However, there was no longer difference in the composite birth trauma, other neonatal or maternal morbidity.ConclusionThe indication for vacuum-assisted vaginal delivery has an impact on neonatal outcome. While cephalohematoma, low 5′ Apgar score, and asphyxia were more common in the non-reassuring fetal heart rate group, neonatal sepsis was more common in cases of prolonged second stage of labor.

Prediction of fetal loss by first-trimester crown–rump length in IVF pregnancies

ObjectiveTo evaluate the association between small crown–rump length (CRL) and fetal loss ≤22xa0weeks in IVF pregnancies.MethodsA retrospective analysis of prospectively collected data at a university-affiliated medical center. All singleton IVF pregnancies within a 5-year period, with a live embryo on first-trimester ultrasound and verified pregnancy outcome were included. Rates of fetal loss ≤22xa0weeks were compared between pregnancies with a CRL ≤tenth percentile and above the tenth percentile of our population.ResultsOverall, 397 pregnancies met inclusion criteria. Ninety-five percent of CRL measurements were performed at 40–80 gestational days. All live-embryo’s CRL measurements, from 40 to 80xa0mm, were plotted against expected gestational age (in 5-day clusters), with calculation of the tenth percentile for every gestational age. Total of 64 pregnancies had CRL ≤tenth percentile for gestational age. The rate of fetal loss in this group was significantly higher than in pregnancies with CRL >tenth percentile (17.2 vs. 6.6%, pxa0=xa00.005, ORxa0=xa02.93, 95% CI 1.2–6.7). In both groups, the majority of fetal losses occurred ≤10xa0weeks of gestation.ConclusionIn IVF pregnancies with a live embryo, a small CRL at 40–80xa0days’ gestation may predict fetal loss. Repeated ultrasound should be considered after 1–2xa0weeks.

EP19.04: Sonographic appearance of the uterus in the early puerperium in vaginal vs Caesarean deliveries: a prospective study

Objectives: Labour induction represents the most frequently conducted interventional procedure to clinical obstetricians. Recently, several studies have shown that induction at term pregnancies could be associated with the maternal and perinatal benefit. The purpose of this study is to critically compare the benefits and risks after labour induction at 39 completed weeks compared to controls expectantly managed. Methods: We conducted a retrospective, observational study of 215 nulliparous women who was admitted to the delivery room at 39 or more weeks of gestation in uncomplicated vertex singleton gestations with intact membranes. We compared the maternal and neonatal benefits and risks of induction group with spontaneous labour group. Results: The 215 women were analysed and among them, the 179 patients delivered vaginally (83.3%). Compared with spontaneous labour group, the induction group at 39 or more weeks of gestation had a similar incidence of Caesarean delivery and blood loss during the delivery (19.4% vs. 16.7%, p=0.099, 1.89±1.27 vs 1.73±1.08 mg/dl in the mean decrement of Hemoglobin, p=0.381, respectively). The maternal length of stay was longer in induction group (3.83±1.42 vs. 4.33±1.52 in days, p=0.03). Regarding neonatal outcomes, both groups had similar Apgar score at 1 and 5 min including less than <7 at 5 min and labour induction was not associated with increased NICU admission rate (15.0% vs. 23.2, p=0.184) or neonatal intubation rate (3.3% vs. 5.8%, p=0.460). In spontaneous labour group, the rate of meconium-stained amniotic fluid was higher, however, which was not statistically significant. Conclusions: This study showed that labour induction at 39 or more weeks of gestations does not increase maternal risks including Caesarean delivery and postpartum blood loss compared to spontaneous labour group. Neonatal adverse events were also comparable outcomes. It may be acceptable to schedule labour induction a few days prior to EDC even when the indication is only relative.