Yossef Ezra

Ehlers-Danlos Type IV in Pregnancy

Background: Ehlers-Danlos syndrome is a heterogeneous group of connective tissue disorders, characterized by a defect in the synthesis of collagen. The syndrome is subdivided into different clinical subtypes, the most hazardous of which is type IV, the vascular type. It can manifest itself in various complications such as rupture of arteries and hollow organs. The obstetrical manifestations are the risk of uterine rupture during labor, damage to the vagina and perineum, bleeding and rupture of blood vessels and colon during the puerperium. Case Report: We describe a primigravida suffering from Ehlers-Danlos type IV who was followed and successfully delivered by a cesarean section at 36 weeks of gestation and made an uneventful recovery. Conclusion: Following a thorough literature review, it seems wise to perform early delivery by cesarean section for pregnant women suffering from Ehlers-Danlos type IV.

Significance of success rate of external cephalic versions and vaginal breech deliveries in counseling women with breech presentation at term

OBJECTIVEnTo appreciate the role of success rates of external cephalic versions and breech deliveries, in order to assess the risk reduction in women with breech presentation at term.nnnSTUDY DESIGNnWe reviewed the patient files of all women with breech presentation whom had an attempt of external cephalic version (ECV) at term. Most of the ECVs were performed under intravenous ritodrine infusion. All women had a trial of labor (TOL) as long as they did not meet one or more of the exclusion criteria of vaginal delivery. Success rates of ECV and TOL were assessed, and statistical analysis was performed by using the student t-test for continuous data, and the Chi-square and Fishers exact tests for categorical data. Statistically significant differences required a P value of <0.05.nnnRESULTSnOf all women with breech presentation at term and not in labor, who had no contraindication for an ECV, 164 consented and were included in the study. The success rate of ECV was 30% (22/74) and 67% (60/90) for nulliparae and multiparae, respectively. Multiparity was the only significant positive predicting variable for ECV success (OR=4.73, 95% CI 4.19-5.27, P=0.00001). Of all the women that underwent a successful ECV, 18/22 primiparae (82%), and 52/60 multiparae (87%) had a vaginal delivery, compared to only 52% of the primiparae and 63% of the multiparae that reached labor with a breech presentation. There were no significant perinatal complications except for one case of mild placental abruption. In the primiparous women, ECV decreased the chance of cesarean delivery by only 9% (P=0.2), compared to a 16% decrease in the multiparae (P=0.019).nnnCONCLUSIONSnWhen counseling women with breech presentation at term, complete information is needed for consent, and should take into account the success rate of ECVs and of vaginal breech deliveries in the specific center.

Legionnaire's disease during pregnancy: a case presentation and review of the literature

Acute pneumonia complicating pregnancy can have serious consequences for both the mother and the fetus. Streptococcus pneumoniae remains the most common bacterial pathogen, but Legionella pneumophila must be considered as well, especially in severe multisystem disease. With severe disease, premature delivery may occur as has been described in the only previous report of Legionnaires disease during pregnancy. We present here the first report of Legionnaires disease in pregnancy, resulting in the term delivery of a healthy infant. Also presented is an extensive review of the literature.

The outcome of grand-multiparous pregnancies of Arabic and Jewish populations in peripheral and central areas of Israel

Objective. To compare the antepartum and intrapartum course of Jewish and Arab great‐grandmultiparas from central and peripheral areas in Israel to age‐matched control multiparous women.

The Association of Maternal Intrapartum Subfebrile Temperature and Adverse Obstetric and Neonatal Outcomes

BACKGROUNDnSubfebrile intrapartum maternal temperature is very common, yet there is sparse evidence regarding its causes or its effects on perinatal outcomes. We examined whether mild temperature elevation during labour is a risk marker for adverse obstetric and neonatal outcomes.nnnMETHODSnA retrospective cohort analysis including 42u2009601 term, singleton live-births in two medical centres between 2003 and 2010 was performed. This study compared women who experienced a maximal intrapartum temperature of ≤37°C with women who experienced subfebrile intrapartum temperature (37.1-37.9°C). Adjusted risks for adverse obstetric and neonatal outcomes were calculated by using multivariable logistic regression models.nnnRESULTSnCompared with maternal temperatureu2009≤u200937°C, subfebrile temperature was associated with higher rates of primary caesarean deliveries {adjusted odds ratios [aOR]u2009=u20091.36 [95% confidence interval (CI) 1.25, 1.49])} and assisted vaginal deliveries (aORu2009=u20091.20 [95% CI 1.11, 1.30]), as well as with greater risks of early neonatal sepsis (aORu2009=u20092.66 [95% CI 1.88, 3.77]), neonatal intensive care unit admissions (aORu2009=u20091.40 [95% CI 1.08, 1.83]), and neonatal asphyxia or seizures (aORu2009=u20093.18 [95% CI 1.51, 6.70]). Mildly elevated maternal intrapartum temperature (37.1-37.5°C) was also associated with adverse outcomes.nnnCONCLUSIONSnMaternal intrapartum subfebrile temperature may be an indicator of operative delivery and neonatal morbidity. Further research is needed to confirm these findings and to reveal underlying mechanisms.