Michal Simchen
Tel Aviv University, OBSTETRICS&GYNECOLOGY, Faculty Member
Background: Rheumatic mitral stenosis (MS) is a relatively rare diagnosis in the developed countries and its treatment during pregnancy is challenging due to hemodynamic changes. With the demographic changes due to recent waves of... more
Background: Rheumatic mitral stenosis (MS) is a relatively rare diagnosis in the developed countries and its treatment during pregnancy is challenging due to hemodynamic changes. With the demographic changes due to recent waves of immigration an increase in the prevalence of rheumatic heart disease is expected. Objectives: To evaluate maternal and neonatal complications in patients with mitral stenosis. Methods: During the years 2006-2017, 22 women who underwent 31 pregnancies were followed at the Sheba Medical Center in Israel. We collected on regarding hemodynamic changes and their clinical course. MS was classified as mild, moderate, or severe according to mitral valve area by echocardiography. Maternal and fetal adverse events were evaluated according to severity of MS and compared by Poisson regression modeling. Results: MS was severe in 7 pregnancies (22.6%), moderate in 9 (29%), and mild in 15 (48.4%). Twenty patients were managed conservatively and 2 underwent a successful percutaneous mitral balloon valvuloplasty (PBMVP) during pregnancy. All pregnancies ended with a liveborn neonate and with no maternal mortality. Peak and mean mitral pressure gradients increased during pregnancy from 13.3 ± 5.3 to 18.6 ± 5.1 mmHg and from 5.9 ± 2.3 to 9.6 ± 3.4 mmHg respectively (P < 0.05). Eight pregnancies (25.8%) were complicated by pulmonary congestion, 2/15 (13.3%) with mild MS, 2/9 (22.2%) with moderate, and 4/7 (57.1%) with severe MS. The adverse event rate was higher among patients with severe MS compared with moderate and mild MS [hazard ratio (HR) 3.15, 95% confidence interval (95%CA) 1.04-9.52 and HR 4.06, 95%CI 1.4-11.19 respectively, P < 0.05]. Nine of 31 deliveries were vaginal; 6 of 22 cesarean sections (27.3%) were performed for cardiac indications. Conclusions: The number of total adverse events were higher among patients with severe MS. Patients with moderate and mild MS should be treated attentively, but good obstetric and maternal outcome can be expected.
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While the immediate effects of pregnancy on aortic dimension in patients with Marfan syndrome (MFS) have been evaluated, the late effects of subsequent pregnancies in these patients are less known. For this purpose, we evaluated 2 groups... more
While the immediate effects of pregnancy on aortic dimension in patients with Marfan syndrome (MFS) have been evaluated, the late effects of subsequent pregnancies in these patients are less known. For this purpose, we evaluated 2 groups of women with MFS who were under specialized care in our institution. Group A included 23 women with MFS who experienced 55 pregnancies; group B included 12 nulliparous MFS patients. Patients in group A were similar in age (36.13 ± 5.6 years vs. 34.25 ± 6.54 years, p = 0.41) and follow-up time (group A 6.05 ± 3.56 years and group B 4.92 ± 3.37 years, p = 0.37). Baseline aortic root diameters as well as the aortic root diameters at follow-up visits were similar between groups (35.60 ± 4.42 vs. 35.08 ± 3.82 mm, p = 0.73, and 37.57 ± 4.66 vs. 37.33 ± 4.83 mm, p = 0.89, respectively). The aortic root diameter increased by 0.5 (0, 2) mm in group A and 1 (0, 4.5) mm in group B (p = 0.54). The rate of aortic dilation per year of follow-up was similar between the groups (0.34 ± 0.52 mm/year in group A vs. 0.55 ± 0.75 mm/year in group B [p = 0.52]). Chronic medical treatment was similar in both groups. Patients in both groups were treated similarly with β-blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers. In summary, subsequent pregnancies in patients with MFS were not associated with an increase in the rate of aortic root dilation in these patients.
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Research Interests: Child health, Child Development, Cerebral Palsy, Birth Weight, Humans, and 15 moreLow Birth Weight, Female, Male, Infant, Dietary Supplements, Clinical Sciences, Bronchopulmonary Dysplasia, Gestational Age, Case Control Study, Gestation, Intraventricular Hemorrhage, JAMA, Confidence Interval, Docosahexaenoic Acid, and Infant Premature
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Research Interests: Cardiology, Obstetrics, Medicine, Prospective studies, Pregnancy, and 15 moreHumans, Preeclampsia, Female, Exercise, American, Adult, Fetus, Gestational Age, Perinatal Outcome, Gestation, Placental Insufficiency, Pregnancy Outcome, Intrauterine Growth Restriction, Cardiac output, and Paediatrics and reproductive medicine
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The simultaneous occurrence of pregnancy and multiple myeloma (MM) is rare. The challenge of diagnosing MM during pregnancy is demonstrated in the case presented here. Despite the rarity of concurrent MM and pregnancy, this possibility... more
The simultaneous occurrence of pregnancy and multiple myeloma (MM) is rare. The challenge of diagnosing MM during pregnancy is demonstrated in the case presented here. Despite the rarity of concurrent MM and pregnancy, this possibility should be considered in patients with signs and symptoms that may be attributed to MM so as not to delay the diagnosis and decision about pregnancy continuation and initiation of an appropriate and safe therapy to the mother and fetus. Treating physicians should be aware of the potential effects of MM therapies on the fetus and pregnancy outcomes.
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Abstract Objective: The objective of this study is to investigate the clinical features of pregnancy in women with Takayasu’s arteritis managed in a tertiary medical center and review the literature in order to establish the course and... more
Abstract Objective: The objective of this study is to investigate the clinical features of pregnancy in women with Takayasu’s arteritis managed in a tertiary medical center and review the literature in order to establish the course and recommended follow up and treatment for these pregnancies. Materials and methods: Retrospective analysis of 20 pregnancies in 6 women with Takayasu’s arteritis. Patients were recruited from the high risk pregnancy clinics at Sheba Medical Center, where follow up included strict control of blood pressure and treatment of obstetric and disease-related complications. Results: Mean maternal age was 29.3 ± 3 years. Thirty-six patients had both supra and infradiaphragmatic arterial disease, of them two had an abdominal aorta involvement and three out of six patients had an isolated supradiaphragmatic disease. Of 20 pregnancies, six pregnancies (30%) resulted in early spontaneous miscarriages, and one pregnancy was terminated at 17 weeks due to fetal anomalies. The remaining 13 pregnancies (65%) resulted in live births. Three out of 13 (23%) neonates were small-for-gestational-age. The most common complication was maternal hypertension affecting 8/13 (61.5%) pregnancies. Preeclampsia occurred in one pregnancy. Four out of 13 (30.7%) pregnancies necessitated preterm induction of labor due to obstetric indications or uncontrolled disease. Conclusions: Although Takayasu’s arteritis is associated with pregnancy complications, tight preconception disease control, strict follow up, and targeted treatment of high blood pressure can result in positive pregnancy outcome.
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A single course of antenatal corticosteroids (ACS) is associated with a reduction in respiratory distress syndrome and neonatal death. Multiple Courses of Antenatal Corticosteroids Study (MACS), a study involving 1858 women, was a... more
A single course of antenatal corticosteroids (ACS) is associated with a reduction in respiratory distress syndrome and neonatal death. Multiple Courses of Antenatal Corticosteroids Study (MACS), a study involving 1858 women, was a multicentre randomized placebo-controlled trial of multiple courses of ACS, given every 14 days until 33+6 weeks or birth, whichever came first. The primary outcome of the study, a composite of neonatal mortality and morbidity, was similar for the multiple ACS and placebo groups (12.9% vs. 12.5%), but infants exposed to multiple courses of ACS weighed less, were shorter, and had smaller head circumferences. Thus for women who remain at increased risk of preterm birth, multiple courses of ACS (every 14 days) are not recommended. Chronic use of corticosteroids is associated with numerous side effects including weight gain and depression. The aim of this postpartum assessment was to ascertain if multiple courses of ACS were associated with maternal side effects. Three months postpartum, women who participated in MACS were asked to complete a structured questionnaire that asked about maternal side effects of corticosteroid use during MACS and included the Edinburgh Postnatal Depression Scale. Women were also asked to evaluate their study participation. Of the 1858 women randomized, 1712 (92.1%) completed the postpartum questionnaire. There were no significant differences in the risk of maternal side effects between the two groups. Large numbers of women met the criteria for postpartum depression (14.1% in the ACS vs. 16.0% in the placebo group). Most women (94.1%) responded that they would participate in the trial again. In pregnancy, corticosteroids are given to women for fetal lung maturation and for the treatment of various maternal diseases. In this international multicentre randomized controlled trial, multiple courses of ACS (every 14 days) were not associated with maternal side effects, and the majority of women responded that they would participate in such a study again.
Research Interests: Pediatrics, Medicine, Birth Weight, Affect, Pregnancy, and 15 moreHumans, Placebo, Postpartum Depression, Female, Patient Satisfaction, Placebos, Lung, Newborn Infant, Adult, Randomized Controlled Trial, Gestational Age, Elsevier, Premature Birth, Adrenal cortex hormones, and Paediatrics and reproductive medicine
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Fetal cardiac calcifications are defined as diffuse hyperechogenicities in the different layers of the heart. This is an uncommon fetal ultrasound finding associated with significant myocardial dysfunction. We report four cases with... more
Fetal cardiac calcifications are defined as diffuse hyperechogenicities in the different layers of the heart. This is an uncommon fetal ultrasound finding associated with significant myocardial dysfunction. We report four cases with massive fetal myocardial calcifications detected on prenatal ultrasound at 18–22 weeks' gestation and associated, in all cases, with significant cardiac dysfunction. Detailed fetal echocardiographic evaluation, chromosome analysis, and an extensive search for intrauterine infection as a cause of these abnormalities, were carried out on all cases. A thorough autopsy was performed on all deceased fetuses and postnatal investigation of the sole survivor was performed. Two of our patients chose to interrupt their pregnancies, one fetus suffered intrauterine demise, and one child was born alive. In all of our cases the karyotypes were normal, and no specific infectious etiology or maternal autoantibody was noted. Histopathology findings in the non‐survivo...
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BACKGROUND Rheumatic mitral stenosis (MS) is a relatively rare diagnosis in the developed countries and its treatment during pregnancy is challenging due to hemodynamic changes. With the demographic changes due to recent waves of... more
BACKGROUND Rheumatic mitral stenosis (MS) is a relatively rare diagnosis in the developed countries and its treatment during pregnancy is challenging due to hemodynamic changes. With the demographic changes due to recent waves of immigration an increase in the prevalence of rheumatic heart disease is expected. OBJECTIVES To evaluate maternal and neonatal complications in patients with mitral stenosis. METHODS During the years 2006-2017, 22 women who underwent 31 pregnancies were followed at the Sheba Medical Center in Israel. We collected on regarding hemodynamic changes and their clinical course. MS was classified as mild, moderate, or severe according to mitral valve area by echocardiography. Maternal and fetal adverse events were evaluated according to severity of MS and compared by Poisson regression modeling. RESULTS MS was severe in 7 pregnancies (22.6%), moderate in 9 (29%), and mild in 15 (48.4%). Twenty patients were managed conservatively and 2 underwent a successful percu...
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OBJECTIVES Antiphospholipid antibodies have been associated with various obstetric complications, including recurrent pregnancy loss, preeclampsia, intrauterine growth restriction, placental insufficiency, and late fetal loss. Despite the... more
OBJECTIVES Antiphospholipid antibodies have been associated with various obstetric complications, including recurrent pregnancy loss, preeclampsia, intrauterine growth restriction, placental insufficiency, and late fetal loss. Despite the amassed body of evidence emphasizing the association between antiphospholipid antibodies and preeclampsia, the severity of preeclampsia with regard to antiphospholipid antibodies status has not been elucidated. This study aimed to evaluate whether early-onset preeclampsia with severe features before 34 weeks' gestation is clinically different when associated with antiphospholipid antibodies. STUDY DESIGN In this retrospective case-control study, we collected data on pregnancy outcomes of 101 women with singleton pregnancies who delivered prior to 34 weeks of gestation due to preeclampsia with severe features. The antiphospholipid antibodies status of 55 of these women was available for analysis. The study group comprised 20 women with positive antiphospholipid antibodies (positive-aPL group), while the control group comprised 35 women without antiphospholipid antibodies (negative-aPL group). Obstetric and neonatal outcomes, laboratory results and pregnancy complications were extracted from medical records. RESULTS In the clinical setting of early-onset preeclampsia with severe features necessitating delivery before 34 weeks gestation, positive-aPL women were hospitalized earlier (29, IQR 26.3-32, vs. 32, IQR 28-33 weeks gestation, P = 0.05), gave birth at a significantly earlier gestational age (30, IQR 28.3-32.8 vs. 33, IQR 30-34, P = 0.02) with a lower mean birth-weight (1266.7 ± 579.6 vs. 1567.3 ± 539.7 g, P = 0.058) compared with negative-aPL women. Furthermore, platelet nadir was significantly lower for positive-aPL compared with negative-aPL women (97 ± 49×103/µL vs. 141 ± 61×103/µL, P < 0.001) and maximal serum creatinine was higher (1.0 ± 0.3 mg/dL vs. 0.9 ± 0.1 mg/dL, P = 0.03). Rates of neonatal complications were low and comparable between groups, except for higher rates of retinopathy of prematurity requiring treatment in the study group (30.0% vs. 5.7%, p = 0.02), and there was a trend for higher perinatal mortality among study group infants. CONCLUSIONS The presence of antiphospholipid antibodies in women with early-onset preeclampsia with severe features is associated with earlier, more severe disease course. Expedited screening for antiphospholipid antibodies in cases of early-onset severe preeclampsia may be considered, along with close monitoring for pregnant women with positive antibodies.
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The effect of additional treatments combined with conventional therapy on pregnancy outcomes was examined in high-risk primary antiphospholipid syndrome (PAPS) patients to identify the most effective treatment strategy. The study's... more
The effect of additional treatments combined with conventional therapy on pregnancy outcomes was examined in high-risk primary antiphospholipid syndrome (PAPS) patients to identify the most effective treatment strategy. The study's inclusion criteria were (1) positivity to lupus anticoagulant alone or associated with anticardiolipin and/or anti-β2 glycoprotein I antibodies; (2) a history of severe maternal-foetal complications (Group I) or a history of one or more pregnancies refractory to conventional therapy leading to unexplained foetal deaths not associated with severe maternal-foetal complications (Group II). Two different additional treatments were considered: oral-low-dose steroids (10-20 mg prednisone daily) and/or 200 to 400 mg daily doses of hydroxychloroquine and parenteral-intravenous immunoglobulins at 2 g/kg per month and/or plasma exchange. The study's primary outcomes were live birth rates and pregnancy complications. A total of 194 pregnant PAPS patients att...
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The incompatibility causing fetal and neonatal alloimmune thrombocytopenia (FNAIT) results from a fetus inheriting a paternal human platelet antigen (HPA), which is different from the maternal HPA. We present a unique case of FNAIT in a... more
The incompatibility causing fetal and neonatal alloimmune thrombocytopenia (FNAIT) results from a fetus inheriting a paternal human platelet antigen (HPA), which is different from the maternal HPA. We present a unique case of FNAIT in a pregnancy involving an oocyte recipient mother with Turner syndrome. This is the first report of FNAIT in which the suggested mechanism involves antibodies produced by a gestational mother against the incompatible HPA of the oocyte donor.
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Patients with Marfan syndrome (MS) face a high risk of aortic dissection during pregnancy. A dilated aortic root (>40 to 45 mm) is considered a relative contraindication for pregnancy. We investigated the risk for aortic dissection and... more
Patients with Marfan syndrome (MS) face a high risk of aortic dissection during pregnancy. A dilated aortic root (>40 to 45 mm) is considered a relative contraindication for pregnancy. We investigated the risk for aortic dissection and pregnancy outcome in patients with MS. Women with MS who attended our cardiology high-risk pregnancy clinic from 2006 to 2015 were followed clinically and with serial echocardiograms by a multidisciplinary team. Beta blockers were offered and titrated by blood pressure and heart rate. Patients with aortic root dilation ≥40 mm were considered high-risk patients with MS. A consistent increase in aortic root diameter of >1 mm during pregnancy was classified as dilation during pregnancy; 31 pregnancies in 19 patients with MS were followed. Four pregnancies were terminated early because of prenatal diagnosis of fetal MS and 4 additional babies born with MS. Eight pregnancies were in patients with a dilated aortic root (40 to 46 mm); 21 patients (68%) were treated with β blockers. There were 2 cases of postpartum aortic dissection (6.5%): 1 type A dissection in a woman with a dilated aortic root who declined β blockers (1 of 8, 12.5%) and 1 type B dissection. Increasing aortic root diameter (>1 mm) in pregnancy was significantly associated with later aortic dissection (2 of 6 vs 0 of 21, p = 0.04). No maternal deaths occurred. All high-risk women with MS gave birth by cesarean section, whereas in the non-high-risk group mode of delivery was by obstetric indication. Preterm delivery rate was 41% (11 of 27). One antenatal fetal death and no major neonatal morbidity or mortality were observed. In conclusion, pregnant patients with MS, especially those with a dilating aortic root, are at high risk of aortic dissection, even with tight control of blood pressure and heart rate.
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Objective:To compare indications for delivery and neonatal morbidities between twins and singletons born between 34 and 35 weeks of gestation.Study design:A prospective observational study was performed in which all infants born between... more
Objective:To compare indications for delivery and neonatal morbidities between twins and singletons born between 34 and 35 weeks of gestation.Study design:A prospective observational study was performed in which all infants born between January and August 2008, at Sheba Medical Center at 34 0/7–35 6/7 weeks of gestational age were included. Indications for delivery, infants’ morbidities and medical interventions were documented. Twins and singletons were compared for antenatal maternal characteristics, risks of short-term neonatal complications and interventions.Results:One hundred and seventy-three mothers and 229 neonates (114 twins and 115 singletons) were included. Background maternal characteristics as well as the use of antenatal steroids and MgSO4 were similar between the groups. Only 44% of all deliveries were spontaneous, while the rest were indicated deliveries. Twins were born lighter and 31.9% of them were SGA. Nevertheless, singletons were significantly more likely to r...
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Peripartum cardiomyopathy (PPCM) is an infrequent form of cardiomyopathy causing significant maternal morbidity and mortality. We aimed to evaluate the risk factors, characteristics and prognosis of PPCM during the index and subsequent... more
Peripartum cardiomyopathy (PPCM) is an infrequent form of cardiomyopathy causing significant maternal morbidity and mortality. We aimed to evaluate the risk factors, characteristics and prognosis of PPCM during the index and subsequent pregnancies.: A retrospective cohort of 36 women with PPCM in a tertiary medical center was analyzed and compared with 10,370 women who gave birth during a single calendar year at the same institution.Women diagnosed with PPCM were older (mean 33.5 years) than controls. A significantly higher proportion were primiparous (63.9%), carried multifetal pregnancies (33.3%) and had hypertensive pregnancy complications (38.9%). Thirty-six percent of PPCM patients conceived with: Risk factors for peripartum cardiomyopathy include primiparity, hypertension and multifetal pregnancies. Assisted reproduction techniques are not independently associated with PPCM but rather through other risk factors for PPCM. The degree of cardiac dysfunction at diagnosis and time ...
Research Interests: Obstetrics, Medicine, Israel, Heart Failure, Perinatal Medicine, and 15 morePregnancy, Humans, Hypertension, Female, Follow-up studies, Risk factors, Clinical Sciences, Adult, Retrospective Studies, Risk Factors, Cardiomyopathies, Parity, Multiple Pregnancy, Peripartum Cardiomyopathy, and Paediatrics and reproductive medicine
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Objective: To ascertain the most common early morbidities in a cohort of infants born at 34-35 weeks gestation and to identify the risk factors associated with these morbidities. Methods: Retrospective analysis of data collected... more
Objective: To ascertain the most common early morbidities in a cohort of infants born at 34-35 weeks gestation and to identify the risk factors associated with these morbidities. Methods: Retrospective analysis of data collected prospectively for all 235 infants born at 34-35 weeks of gestation during an eight-month period at a single tertiary medical center. Study group infants (SG) were compared with 470 term infants (TI), matched both for gender and for mode of delivery. Results: Jaundice requiring phototherapy (32%), respiratory disease (19.1%) and cyanotic episodes (15.7%) were the most frequent early morbidities, followed by hypoglycemia, temperature instability and feeding intolerance. The risk of having a complication was 13.3-times higher in the SG compared with the TI group (95% CI 8.9-19.6, p < 0.001). Modifiable interventions associated with these morbidities were antenatal steroids, MgSO4 and mode of delivery. Non-modifiable factors were maternal age, parity, twins a...
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Research Interests: Obstetrics, Nonparametric Statistics, Carbon Dioxide, Medicine, Pregnancy, and 15 moreHumans, Female, Hyperventilation, Adult, Fetus, Uterus, Hyperoxia, Blood Flow Velocity, Middle Cerebral Artery, Case Control Studies, Vascular Resistance, PCO, Arteries, Paediatrics and reproductive medicine, and Uterine Artery
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Research Interests: Obstetrics, Medicine, Perinatal Medicine, Pregnancy, Humans, and 15 morePlacenta, Female, Male, Clinical Sciences, Newborn Infant, Adult, Gestational Age, Pregnancy Outcome, Intrauterine Growth Restriction, Case Control Studies, placental abruption, Pregnancy complications, Paediatrics and reproductive medicine, Abruptio placentae, and Fetal Growth Retardation
To longitudinally assess the neurodevelopmental outcomes of late preterm infants (LPI) through the first year of life and to investigate for perinatal conditions that may affect developmental outcomes. The study population comprised of... more
To longitudinally assess the neurodevelopmental outcomes of late preterm infants (LPI) through the first year of life and to investigate for perinatal conditions that may affect developmental outcomes. The study population comprised of 124 LPI, born in a single Israeli inborn center over an eight months period. Thirty-three term infants (TI) were recruited for comparison. Alberta Infant Motor Scale (AIMS) for gross motor evaluation was performed at 6 months of age and the Griffiths Mental Development Scales (GMDS) were performed at 12 months (chronological age). Maternal and neonatal covariates, potentially associated with low developmental scores, were analyzed by multivariate logistic regression models. At chronological age of 6 and 12 months, LPI performed significantly lower than TI on all subscales, but when scores were corrected for post conception age, developmental scores were similar in the two groups. In a multivariate model of logistic regression, male gender, emergent cesarean section and higher maternal education (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;14 years) were found to be associated with increased risk for lower developmental scores at 12 month of age in LPI. LPI do not complete their neurodevelopmental maturation by the first year of life. Males and those born after emergent cesarean section (CS) are at increased risk for lower developmental scores. Correction of age to term birth in LPI may still be needed at this age.
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Research Interests: Obstetrics, Medicine, Pregnancy, Humans, Female, and 15 moreAdult, Retrospective Studies, Cesarean Section, Gestational Age, Gestation, Preterm Delivery, Cervix, Pregnancy Outcome, Preterm Labor, Cervical Ripening, Higher order, High risk, Cervical dilatation, Paediatrics and reproductive medicine, and Obstetric Labor Premature
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The objective of this paper is to examine whether growth-restricted preterm infants have a different neonatal outcome than appropriately grown preterm infants. All consecutive, singleton preterm deliveries between 27-35 weeks&#39;... more
The objective of this paper is to examine whether growth-restricted preterm infants have a different neonatal outcome than appropriately grown preterm infants. All consecutive, singleton preterm deliveries between 27-35 weeks&#39; gestation were included over a 4-year period. Infants with congenital anomalies and infants of diabetic mothers were excluded. Infants were categorized as small-for-gestational-age (SGA) when birth weight was at or below the 10th percentile, and appropriate-for-gestational-age (AGA) when between the 11th and 90th percentiles. Outcome variables included: neonatal death, respiratory distress syndrome (RDS), sepsis, intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Neonatal morbidity and mortality were examined by univariate and stepwise multivariate logistic regression analyses. Factors controlled for during the analysis included: maternal age; gestational age; mode of delivery; presence of preeclampsia, HELLP syndrome, prolonged premature rupture of membranes (PROM), placental abruption, placenta previa, prenatal steroid exposure, infant gender, and low Apgar score. Seventy-six infants were included in the SGA group and 209 in the AGA group. SGA infants had a higher mortality rate (p = 0.003). They also had more culture-proven sepsis episodes (p = 0.001). No differences were found with respect to the other outcomes. The results were similar when analyzed separately for the group of infants born at or below 32 weeks&#39; gestation. Growth-restricted preterm infants were found to have both higher mortality and infection rates compared with AGA preterm infants. Growth restriction in the preterm neonate was not found to protect against other neonatal outcomes associated with prematurity. When considering elective preterm delivery for this high-risk group of pregnancies, the increased risks in the neonatal period should be taken into account.
Research Interests: Obstetrics, Pediatrics, Medicine, Israel, Neonatal Necrotizing Enterocolitis, and 15 moreBirth Weight, Humans, American, Small for Gestational Age, Clinical Sciences, Newborn Infant, Morbidity, Retrospective Studies, Gestational Age, Intraventricular Hemorrhage, Logistic Models, Respiratory distress, Paediatrics and reproductive medicine, Fetal Growth Retardation, and Infant Premature
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Our purpose was to investigate factors that might influence serum magnesium levels during intravenous magnesium sulfate tocolytic therapy. Thirty-three women receiving magnesium sulfate for preterm labor participated in this prospective,... more
Our purpose was to investigate factors that might influence serum magnesium levels during intravenous magnesium sulfate tocolytic therapy. Thirty-three women receiving magnesium sulfate for preterm labor participated in this prospective, observational study. Gestational ages were 24 to 34 weeks. Four groups of women were identified according to the maintenance magnesium infusion rate required for arresting preterm labor after 5 g of therapy induction: 1.5, 2, 2.5, and 3 g/h. Serum magnesium samples were drawn after a predefined period of at least 18 hours of arrested preterm labor, at a minimum of every 6 hours. Variables examined included serum albumin; serum protein; serum ionized calcium; serum creatinine; creatinine clearance; 24-hour urine output; maternal height, weight, body surface area; and body mass index. By use of a multivariate stepwise regression model we identified four variables that independently and significantly contributed to the model: magnesium infusion rate (P &lt; .001); total serum protein level (P &lt; .001); serum creatinine level (P = .009); and maternal weight squared (P = .026). Seventy-two percent of the variance was accounted for by use of these parameters. A predictive linear model, developed to relate these factors, produced the following formula: Suggested magnesium infusion rate = 0.89 x Serum magnesium concentration (mg/dL) - 3.16 x Serum creatinine (mg/dL) - 0.66 x Serum total proteins (g/dL) + 0.0001 x (maternal weight)2 (kg) + 2.30. Serum creatinine, serum protein, and maternal weight can be used to adjust the dose of magnesium sulfate in patients with premature labor to achieve therapeutic serum levels of magnesium more rapidly and safely.
Research Interests: Medicine, Linear models, Linear Model, Pregnancy, Humans, and 15 moreMagnesium, Female, Body Mass Index, Adult, Body Weight, Gestational Age, Observational Study, Magnesium Sulfate, Preterm Labor, Creatinine, Blood Proteins, creatinine clearance, BODY SURFACE AREA, Paediatrics and reproductive medicine, and Obstetric Labor Premature
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Research Interests: Obstetrics, Risk, Medicine, Pregnancy, Population, and 15 moreHumans, Female, Antiphospholipid antibodies, Adult, Public health systems and services research, Retrospective Studies, Gestation, Pregnancy Outcome, Premature Birth, Cohort Studies, Lupus Anticoagulant, Antiphospholipid Syndrome, Adverse effect, Pregnancy complications, and Paediatrics and reproductive medicine
Homozygous carriers of factor V Leiden (FVL) have an up to 80-fold increased risk of venous thrombosis, but the risk of obstetric complications in FVL homozygosity is unclear. To compare obstetric and thromboembolic complications among... more
Homozygous carriers of factor V Leiden (FVL) have an up to 80-fold increased risk of venous thrombosis, but the risk of obstetric complications in FVL homozygosity is unclear. To compare obstetric and thromboembolic complications among factor V Leiden (FVL) homozygous and heterozygous carriers treated with prophylactic dose anticoagulation during pregnancy. In this retrospective case-control study we performed a chart review for the years 2004-2010 of homozygous and heterozygous FVL carriers who were treated with low molecular weight heparin (LMWH) at a dose of 0.6 mg/kg/day during pregnancy. Adverse outcomes included thromboembolic and obstetric complications. A composite adverse obstetric outcome was defined as the presence of at least one of the following: late intrauterine fetal demise, severe intrauterine growth restriction (< 5th percentile), preeclampsia, and placental abruption. Pregnancy outcomes of homozygous and heterozygous FVL carriers were compared. We compared the ...
Research Interests: Obstetrics, Medicine, Israel, Pregnancy, Humans, and 15 morePreeclampsia, Female, Chemoprevention, Anticoagulants, Adult, Retrospective Studies, Pregnancy Outcome, Intrauterine Growth Restriction, Case Control Studies, Pre Eclampsia, placental abruption, Factor V Leiden, Medical and Health Sciences, Abruptio placentae, and Fetal Growth Retardation
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The objective of this study was to examine whether there is a difference in the frequency of fetal erythroblasts in maternal blood in pregnancies with intrauterine growth restriction (IUGR) as compared with normal pregnancies. Nucleated... more
The objective of this study was to examine whether there is a difference in the frequency of fetal erythroblasts in maternal blood in pregnancies with intrauterine growth restriction (IUGR) as compared with normal pregnancies. Nucleated red blood cells (NRBC) were isolated from nine pregnant women with ultrasonically diagnosed IUGR (estimated fetal weight less than the 10th percentile for gestational age) and 11 women with appropriately grown fetuses. The frequency of fetal hemoglobin-expressing NRBC (FHE-NRBC) in maternal blood was evaluated by triple density centrifugation and anti-CD71+ magnetic cell sorting, followed by indirect immunocytochemistry for the detection of gamma-chain fetal hemoglobin. The number of FHE-NRBC in 10 ml maternal blood in the IUGR group was higher than in the control group (454.5 vs 56.7, p&lt;0.05). This difference was even more pronounced when FHE-NRBC frequency was calculated relative to the total CD71+ population of cells. There were 118.9 FHE-NRBC per 10(5) CD71+ cells in IUGR pregnancies as compared with 11.5 cells in the control group (p&lt;0.01). There was no difference in the total mean number of CD71+ mononuclear cells between the two groups. The observed increase in the frequency of fetal cells in the maternal circulation found in IUGR pregnancies may be a result of an increase in total NRBC in the fetal circulation or rather of abnormalities in placental structure. This phenomenon may assist in identifying pregnancies at risk for this complication early in the course of the pregnancy, even before actual growth restriction presents itself ultrasonically.
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This study was undertaken to present a possible association between maternal hypercalcemia and fetal polyhydramnion. Five cases of maternal hypercalcemia were diagnosed with otherwise unexplained fetal polyhydramnion. Cases are outlined;... more
This study was undertaken to present a possible association between maternal hypercalcemia and fetal polyhydramnion. Five cases of maternal hypercalcemia were diagnosed with otherwise unexplained fetal polyhydramnion. Cases are outlined; maternal and fetal/neonatal investigation, treatment, and outcome are presented. Fetal polyhydramnion was identified sonographically (mean amniotic fluid index = 32 +/- 11.3 cm). Maternal hypercalcemia (mean 12.8 +/- 1.1 mg/dL) led to the diagnosis of primary hyperparathyroidism. Of the 5 women, 4 underwent parathyroidectomy. One had a hypercalcemic crisis and intrauterine fetal demise. Neonatal hypercalcemia of remaining infants was documented (mean 13 +/- 1 mg/dL), with subsequent hypocalcemia in 1 of the neonates. All mothers and the 4 live neonates were discharged in good condition. We suggest that fetuses exposed to a hypercalcemic environment may have polyuria develop similar to adult hypercalcemic polyuria, leading to fetal polyhydramnion. Maternal serum calcium levels may be part of the investigation in otherwise unexplained polyhydramnion, as maternal hypercalcemia may threaten the health of both mother and fetus.