Yoni Cohen

The influence of prolonged preterm premature rupture of the membranes on neonatal outcome of the presenting and non-presenting twin.

OBJECTIVE To compare the neonatal outcome in twin gestations complicated by prolonged preterm premature rupture of membranes (PPROM). STUDY DESIGN Between the years 2000 and 2010 we identified 48 women with twin pregnancies who were diagnosed as having PPROM and a latency period to delivery >24h. We compared the neonatal morbidity and mortality between the presenting and non-presenting twins, assuming that the rupture occurred in the lower sac. Importantly, in 30 women we were able to identify the location of the ruptured sac by ultrasound examination demonstrating oligohydramnion. In these 30 cases, neonatal outcome of fetuses in the ruptured sac and those in the intact sac were compared. RESULTS The median gestational age was 31 weeks (range 28-33) with a median latency period between PPROM and delivery of 9 days (range 1-18). Of the identified ruptures 90% (27/30) occurred in the lower sac (presenting twin). There was no significant difference between the presenting and non-presenting twin in terms of neonatal morbidity and mortality. Moreover, no difference was found when fetuses with ruptured sac were compared to those with intact membrane sac. Importantly, the outcomes were not affected by the length of the latency period. CONCLUSION The current study results demonstrated that the outcome of fetuses exposed to prolonged preterm rupture of membranes is similar to that of fetuses with intact membranes. Our data suggest that rupture of membranes per se did not cause any deleterious clinical manifestations or lead to clinical discordant inflammation and poor neonatal outcome, supporting a conservative management of twin pregnancies with PPROM.

A New Perspective on the Risk of Hypercoagulopathy in Ovarian Hyperstimulation Syndrome Using Thromboelastography

Thromboelastography (TEG) provides real-time assessment of hemostasis by measuring the viscoelastic properties, coagulation factor, and platelet activity in whole blood samples. In this prospective case–control study, we wanted to investigate whether blood clot formation assessment, using TEG, can identify a hypercoagulable state in women with severe ovarian hyperstimulation syndrome (OHSS). Thirty-six women who were hospitalized with severe OHSS were allocated to the OHSS group and 32 women undergoing controlled ovarian hyperstimulation but who did not develop OHSS were allocated to the control group. The TEG indices were compared between women with severe OHSS and controls. All the coagulation indices assessed by TEG were significantly different in the OHSS group compared to the controls, depicting a hypercoagulable state. Median coagulation index was 3.6 (interquartile range: 2.80-4.15) and 1.45 (interquartile range: 0.20-2.30) in study group and controls, respectively (P < .001). Our results show that TEG can be used to depict a hypercoagulable state in women with severe OHSS.

Reference values for strong ion difference—A novel tool for fetal metabolic assessment

OBJECTIVES The aim of this pilot study was to establish reference values for strong ion difference (SID) in umbilical cord blood and investigate the feasibility of evaluating fetal metabolism according to the comprehensive approach to acid-base abnormalities, based on Stewarts physiochemical theory. STUDY DESIGN A prospective observational study. Women who underwent an elective cesarean section at term (n=40) were compared to women who completed a normal spontaneous delivery at term (n=40). The primary outcome was the establishment of normal values for SID in the umbilical cord vein. We also compared acid-base variables in the umbilical vein between the groups. RESULTS The apparent SID in the umbilical vein was 34.61+/-3.92 mequiv./L after normal delivery and 35.98+/-2.56 mequiv./L after elective cesarean section (the effective SID is 37.43+/-1.93 and 38.29+/-2.38 mequiv./L, respectively). The pH values were similar in both groups, but the pCO(2) was significantly higher and the plasma principal weak acids (albumin and phosphate) were significantly lower after cesarean sections. CONCLUSIONS SID enables a comprehensive approach to acid-base abnormalities in the neonate, making it a potential additional tool for evaluating fetal acid-base status.

The role of C-reactive protein measurement as a diagnostic aid in early pregnancy

OBJECTIVE To investigate the values of C-reactive protein (CRP) in early pregnancy for detection of any abnormality of the conceptus and especially the condition of extra-uterine pregnancy (EUP). STUDY DESIGN In this prospective observational study, we established reference values for CRP in early pregnancy. Next, we tested whether a single, wide-range CRP measurement could serve as a diagnostic tool for abnormal first trimester pregnancy by comparing CRP levels in three different pregnancy statuses: viable intrauterine pregnancy (Group A), EUP (Group B) and delayed abortion (Group C). RESULTS CRP levels were significantly higher in normal pregnancy (Group A) compared to abnormal pregnancy (Group B+C and Group B alone). CRP level was influenced only by the pregnancy status (normal, EUP or delayed abortion) and not by age, BMI, hematocrit or gravidity. The multiple logistic regression model (adjusted for age, gravidity, gestational age, hematocrit and BMI) revealed CRP as being a predictor for normal intrauterine pregnancy. CONCLUSION This study examined the association between CRP levels and abnormal first trimester pregnancies. Our results support single CRP measurement as a diagnostic tool in early pregnancy.

Persistent abdominal pain over uterine scar during labor as a predictor of delivery complications

To evaluate the significance of persistent lower abdominal pain in women with previous cesarean delivery.

Umbilical cord blood collection carry increased maternal bleeding risk during cesarean section.

Objective: Concern has recently been raised over the issue of maternal bleeding during umbilical cord blood (UCB) collection. The risk of maternal hemorrhage and subsequent drop in maternal hemoglobin after UCB collection during elective cesarean section (CS) was assessed. Methods: In this retrospective cohort study, we have compared maternal hemoglobin drop after elective CS in women who choose to collect UCB vs. controls. Results: UCB collection during CS was associated with an increased drop in hemoglobin levels. Significantly more women who chose to collect UCB had drops in hemoglobin levels of >3 g/dL compared to control women (8.70 vs. 1.03%, respectively, p = 0.015). Conclusions: These results demonstrated an increased risk for maternal bleeding when UCB is collected in utero during a CS.