The association between birth weight at term and long-term endocrine morbidity of the offspring*

Objective: To investigate whether small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth weight at-term poses an increased risk for long-term pediatric endocrine morbidity.

Study design: A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to endocrine morbidity of singleton children born SGA, appropriate-for-gestational-age (AGA), and LGA at-term. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders.

Results: During the study period, 235,614 deliveries met the inclusion criteria; of which 4.7% were SGA (n?=?11,062), 91% were AGA (n?=?214,249), and 4.3% were LGA neonates (n?=?10,303). During the follow-up period, children born SGA or LGA at-term had a significantly higher rate of long-term endocrine morbidity. Using a multivariable GEE logistic regression model, controlling for confounders, being delivered SGA or LGA at-term was found to be an independent risk factor for long-term pediatric endocrine morbidity (Adjusted OR?=?1.4; 95%CI?=?1.1–1.8; p?=?.015 and aOR?=?1.4; 95%CI?=?1.1–1.8; p?=?.005, respectively). Specifically, LGA was found an independent risk factor for overweight and obesity (aOR?=?1.7; 95%CI?=?1.2–2.5; p?=?.001), while SGA was found an independent risk factor for childhood hypothyroidism (aOR?=?3.2; 95%CI?=?1.8–5.8; p?=?.001).

Conclusions: Birth weight either SGA or LGA at-term is an independent risk factor for long-term pediatric endocrine morbidity.     

The impact of maternal epilepsy on perinatal outcome in singleton gestations

Objective: We sought to evaluate perinatal outcomes in women with epilepsy.

Methods: We performed a retrospective cohort study between 2007 and 2014, at a tertiary, university-affiliated medical center. All women with singleton gestation who delivered during the study period were included, except for pregnancies in which fetuses with chromosomal or structural anomalies were diagnosed. Perinatal outcome was compared between two groups: women diagnosed with epilepsy and women without epilepsy.

Results: Out of 62,102 deliveries during the study period, 61,455 met the inclusion criteria, of whom 206 (0.3%) had epilepsy. The only difference found in maternal demographics was higher rate of nulliparity in the epilepsy group (p?=?.02). As for maternal adverse outcome, higher rates of placental abruption and longer postpartum admission were found in women with epilepsy (p?=?.02 and p?p?p?=?.02), neonatal intensive care unit (NICU) admissions (OR 1.84, 95%CI 1.25–2.70, p?=?.002), seizures (OR 4.33, 95%CI 1.60–11.77, p?=?.004), transient tachypnea of the newborn (OR 2.47, 95%CI 1.005–6.05, p?=?.049) and respiratory distress syndrome (OR 7.16, 95%CI 2.47–20.76, p?Conclusions: Epilepsy in pregnant women is associated with adverse perinatal outcomes, including neonatal seizures, placental abruption and respiratory problems.     

Adolescence and risk of preterm birth in multifetal gestations

Objective: The objective of this study is to evaluate if adolescence confers additional risk for preterm delivery in multifetal gestations.

Methods: This is a retrospective review of all twin and triplet deliveries from 8/2008 to 12/2012 at two Detroit Hospitals. Outcomes in adolescent mothers aged 19 or younger (n?=?59) were compared with adult controls aged 20–34 (n?=?350).

Results: Mean gestational age at delivery in adolescents was 31.3 (SD: 5.8) weeks versus 34.2 (SD: 4.3) weeks in adults (p?p?=?.02) and early-preterm delivery (aOR, 2.2; 95% CI 1.2–4; p?=?.01). Adjusted rates of preterm and early-preterm delivery were markedly higher in adolescents compared with controls. Being an adolescent was also a significant risk factor for iatrogenic preterm delivery (aOR, 2.4; 95% CI 1.1–5.5; p?=?.04).

Conclusions: Adolescents pregnant with twins or triplets deliver 3 weeks, on average, before adults and are at markedly increased risk of preterm and early-preterm delivery.     

Perinatal sclerostin concentrations in abnormal fetal growth: the impact of gestational diabetes

Objective: To prospectively evaluate maternal and cord blood concentrations of sclerostin – an osteocyte-secreted factor, inhibiting osteoblast differentiation and bone formation and associated with adverse metabolism – in pregnancies with normal and abnormal fetal growth.

Methods: Plasma sclerostin concentrations were determined by ELISA in 80 maternal and 80?cord blood samples from asymmetric intrauterine-growth-restricted (IUGR, n?=?30), large-for-gestational-age (LGA, n?=?30), and appropriate-for-gestational-age (AGA, n?=?20) singleton full-term pregnancies. Fourteen out of 30 mothers with LGA offspring presented with gestational diabetes mellitus (GDM).

Results: Maternal and fetal sclerostin concentrations did not differ among LGA, IUGR, and AGA groups. Fetal concentrations were higher than maternal. In LGA group, maternal concentrations were elevated in cases of GDM (b?=?13.009, 95%CI 1.425–24.593, p?=?.029). In a combined group and the IUGR group, maternal concentrations were elevated in older mothers (b?=?0.788, 95%CI 0.190–1.385, p?=?.010, and b?=?0.740, 95%CI 0.042–1.438, p?=?.039, respectively).

Conclusions: Maternal and fetal sclerostin concentrations may not be differentially regulated in pregnancies complicated by abnormal fetal growth. Circulating maternal levels are higher in cases of GDM, probably implying reduced bone formation. Sclerostin up-regulation with aging may be one of the molecular pathways responsible for the observed age-related decline in bone synthesis, leading to accelerated bone loss in humans.     

Sociodemographic characteristics associated with the use of effective and less effective contraceptive methods: findings from the Understanding Fertility Management in Contemporary Australia survey

Objective: Unintended pregnancy and abortion may, in part, result from suboptimal use of effective contraception. This study aimed to identify sociodemographic factors associated with the use of effective and less effective methods among women and men of reproductive age living in Australia.

Methods: In a cross-sectional national survey, 1544 women and men aged 18–51 were identified as being at risk of pregnancy. Chi-square and logistic regression analyses were used to assess the sociodemographic factors related to contraceptive use.

Results: Most respondents (n?=?1307, 84.7%) reported using a method of contraception. Use of any contraceptive was associated with being born in Australia (Odds Ratio [OR] 1.89; 95% Confidence Interval [CI]1.186, 3.01; p?=?.008), having English as a first language (OR 1.81; 95% CI: 1.07, 3.04; p?=?.026), having private health insurance (OR 2.25; 95% CI 1.66, 3.04; p?p?n?=?534, 34.6%; permanent methods: 23.1%, and long-acting reversible contraception (LARC): 11.4%). Permanent methods were more likely to be used in rural areas (OR 0.62; 95%CI 0.46, 0.84; p?=?.002). Use of the least effective, short-term methods was reported by nearly half (condoms: 25.6%, withdrawal: 12.5%, and fertility-awareness-based methods: 2.8%). Those who relied on withdrawal were more likely to live in a metropolitan area (OR 2.85; 95% CI 1.95, 4.18; p?p?Conclusions: Targeted promotion of the broad range of available contraceptives may raise awareness and uptake of more effective methods and improve reproductive autonomy in certain population groups.     

Catheter-associated urinary tract infection (CAUTI) after term cesarean delivery: incidence and risk factors at a multi-center academic institution

Purpose: The purpose of this study is to identify the rate of catheter-associated urinary tract infection (CAUTI) after Cesarean delivery (CD) and to determine if any factors increase risk of infection.

Methods: A retrospective cohort study was performed at a multi-center institution for patients who underwent CD in 2013. All patients had urinary catheters inserted before surgery. Diagnosis followed IDSA guidelines with culture growing greater than 10³ CFU of bacteria per mL with symptoms or symptomatic urinary tract infections treated at provider discretion. Statistical analysis was assessed with Chi-square and Student’s t-test followed by logistic regression.

Results: Of 2419 patients, 36 patients developed CAUTI (1.5%). In the 24 (66.7%) cases diagnosed by IDSA guidelines, Escherichia coli was the most common causative organism (54.1%); followed by Enterococcus faecalis (16.7%), Streptococccus agalactiae (8.3%), and Group A Streptococcus (8.3%). Longer operative time (OR 1.013; 95% 1.002–1.023; p?=?.02) and pregnancies complicated by STI (OR 4.15; 95% CI 1.11–15.0; p?Conclusions: The overall rate of CAUTI after CD was low at 1.5%. Escherichia coli was the most common causative pathogen. Identification of the patients at high risk for CAUTI allows for risk reduction measures.     

Risk factors for postpartum urinary retention after vaginal delivery at term without epidural anesthesia

Objective: We performed a retrospective case-control study of vaginal delivery at term without epidural anesthesia to identify clinical predictions of postpartum urinary retention (PUR).

Methods: We reviewed the obstetric records of all singleton vaginal deliveries at Japanese Red Cross, Katsushika Maternity Hospital form January 2016 through December 2017.

Results: There were 58 women (2.4%) complicated by PUR and 2391 women without PUR. A multivariate analysis revealed nulliparity, instrumental delivery, and episiotomy as independent risk factors for PUR (nulliparity: adjusted OR 2.39, 95%CI 1.2–4.8, p?=?0.01; instrumental delivery: 3.53, 95%CI 1.9–6.7, p?p?=?.04). While, urination (or urethral catheterization) within 1?hour before delivery revealed as independent prevention factor for PUR (adjusted OR 0.54, 95%CI 0.30–0.99, p?=?.048).

Conclusions: The risk factors identified in our institute seemed to approximately similar to those observed in the institutes capable of performing epidural anesthesia. In addition, urination just before delivery seemed to be an independent prevention factor for PUR.     

Obstetric risk factors for poor neonatal adaptation at birth

Purpose: To identify obstetric risk factors of delivering a neonate with poor neonatal adaptation at birth.

Material and methods: Nested case–control study. Poor neonatal adaptation was defined for presence of at least: umbilical cord artery pH <7.10, base deficit ≥12?mmol/L, Apgar score at 1′ ≤5. Controls were selected from the same population and matched with cases. The association between clinical parameters and poor neonatal adaptation was analyzed by logistic regression.

Results: One hundred and thirty three women (2.1% of all live births) with a neonate presenting a poor neonatal adaptation were matched with 133 subsequent controls. Significant contributions for the prediction of poor neonatal adaptation were provided by maternal age ≥35 years (p?≤?.001, odds ratio (OR) 3.9 [95%CI: 2.3–6.8]), nulliparity (p?≤?.001, OR 3.3 [95%CI: 1.8–6]), complications during pregnancy (p?=?.032, OR 2.2 [95%CI: 1.1–4.4]), gestational age at delivery <37 weeks (p?=?.008, OR 5.2 [95%CI: 1.5–17.8]) and cardiotocography category II or III (p?≤?.001, OR 36.3 [95%CI: 16.5–80.1]). The receiver operative characteristic curve was 0.91 [95%CI: 0.87–0.95], and detection rates 82.7% and 89.5% at 10% and 20% of false positive rates, respectively.

Conclusions: Several obstetric risk factors before and during labor can identify a subgroup of newborns at higher risk of a poor neonatal adaptation at birth.     

The efficacy of myo-inositol supplementation to prevent gestational diabetes onset: a meta-analysis of randomized controlled trials

Introduction: The efficacy of myo-inositol supplementation to prevent gestational diabetes onset remains controversial. We conducted a systematic review and meta-analysis to explore the influence of myo-inositol supplementation on the incidence of gestational diabetes.

Methods: We search PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases through November 2017 for randomized controlled trials (RCTs) assessing the effect of myo-inositol supplementation on gestational diabetes onset. This meta-analysis is performed using the random-effect model.

Results: Five randomized controlled trials (RCTs) are included in the meta-analysis. Compared with control group in pregnant women, myo-inositol supplementation is associated with significantly reduced incidence of gestational diabetes (risk ratio (RR)?=?0.43; 95%CI?=?0.21–0.89; p?=?.02), and preterm delivery (RR?=?0.36; 95%CI?=?0.17–0.73; p?=?.005), but has no substantial impact on 2-h glucose oral glucose tolerance test (OGTT) (mean difference (MD)?=??6.90; 95%CI?=??15.07 to 1.27; p?=?.10), gestational age at birth (MD?=?0.74; 95%CI?=??1.06 to 2.54; p?=?.42), birth weight (MD?=??5.50; 95%CI?=??116.99 to 105.99; p?=?.92), and macrosomia (RR?=?0.65; 95%CI?=?0.20–2.11; p?=?.47).

Conclusions: Myo-inositol supplementation has some ability to reduce the incidence of gestational diabetes and preterm delivery in pregnant women.     

Endomyometritis after cesarean delivery in the era of antibiotic prophylaxis: incidence and risk factors

Purpose: To identify the rate of postpartum endomyometritis (PPE) after cesarean delivery (CD) in the era of antibiotic prophylaxis and determine risk factors.

Methods: A single institution retrospective study was performed in women undergoing CD. Data regarding obstetrical and surgical variables were collected. Diagnosis of PPE was made clinically.

Results: Among 2419 patients, the rate of PPE was 1.6% (n?=?38) and was associated with lower age (27.0 versus 31.0; p?p?p?=?.0081). There was no difference in PPE for cefazolin 2?g versus 1?g (OR: 1.91; p?=?.17) or 3?g versus 1?g (OR: 3.69; p?=?.29), gentamicin/clindamycin versus cefazolin (OR: 5.60; p?p?=?.001), sexually transmitted infection during the pregnancy (OR: 4.197; p?=?.02) or blood transfusion (OR: 9.50; p?Conclusions: While the overall rate of PPE was low, several risk factors were identified. Preoperative diagnosis of chorioamnionitits is associated with a higher rate of PPE. Further studies are needed to identify optimal regimens for antimicrobial prophylaxis in women undergoing CD.     

Effect of antenatal corticosteroids on morbidity and mortality of preterm singletons and twins

Purpose: To compare the effect of antenatal corticosteroids (ACS) on neonatal outcomes among singleton and twin pregnancies and the impact of completeness and timing of ministration.

Materials and methods: Retrospective cohort study involving 951 preterm deliveries (25⁺⁰–34⁺⁶?weeks), between 2006 and 2015. Neonatal outcomes were evaluated according to completeness of ACS (“Complete” n?=?441; “Rescue” n?=?38; “Incomplete” n?=?175; “No ACS” n?=?98) and timing of therapy related to delivery (“Before 7?days” n?=?260; “After 7?days” n?=?181).

Results: On respiratory distress syndrome (RDS), odds ratio (OR) for twins was 0.172, 95% confidence interval (CI) was 0.047; 0.591 and for singletons 0.390 (95%CI 0.214; 0.703) for complete or rescue courses, and 0.280 (95%CI 0.069; 1.066) for twins and 0.906 (95%CI 0.482; 1.698) for singletons for incomplete courses. About the need for mechanical ventilation (MV), twins had an OR of 0.189 (95%CI 0.052; 0.642) and singletons of 0.404 (95%CI 0.222; 0.727) for complete or rescue courses and twins had OR?=?0.225 (95%CI 0.053; 0.874) and singletons of 0.404 (95%CI 0.222; 0.727) for incomplete courses. About timing, group “After 7?days” had OR?=?2.00 for RDS (95%CI 1.21; 3.30) and 2.32 (95%CI 1.42; 3.78) for MV.

Conclusions: ACS improves neonatal outcomes both in singleton and twins. Delivering 7 days after a complete course decreased neonatal morbidity.     

Immediate perinatal outcomes of postterm deliveries

Objective: To investigate whether postterm pregnancy (≥42 0/7 weeks’ gestation) increases the risk for adverse perinatal outcome.

Study design: In this population based cohort study, all singleton deliveries occurring between 1991 and 2014 in a tertiary medical center were included. Pregnancy and perinatal outcomes were compared between postterm and term deliveries (37 0/7 to 41 6/7 weeks’ gestation). Preterm deliveries, unknown gestational age, congenital malformations, and multiple gestations, were excluded. The association between postterm and adverse perinatal outcomes was evaluated using a general estimation equation (GEE) multivariable analyses.

Results: During the study period, 226,918 deliveries were included in the analysis. Of them, 95.9% (n?=?217,544) were term and 4.1% (n?=?9374) were postterm. Post-term pregnancies were more likely to be complicated with oligohydramnios, macrosomia, meconium stained amniotic fluid, shoulder dystocia, low Apgar scores, and hysterectomy (p?Conclusions: Post-term delivery involves higher rates of adverse perinatal outcomes and is independently associated with significant perinatal mortality.     

Genetic susceptibility analysis of GCLC rs17883901 polymorphism to preeclampsia in Chinese Han women

Abstract

Preeclampsia (PE) is a specific obstetric disorder that may result in maternal and neonatal morbidity and mortality. Increasing evidence has been indicated that some candidate genes related to oxidative stress, such as glutamate-cysteine ligase, catalytic subunit (GCLC), glutamate-cysteine ligase, modifier subunit (GCLM), involve in the pathogenesis of PE. After the genetic contribution of GCLC rs17883901 polymorphism was analyzed by TaqMan allelic discrimination real-time PCR in 1001 PE patients and 1182 normal pregnant women, a case-control association analysis was performed. Although no statistical difference was found in genetic distribution of rs17883901 in GCLC between PE and control group (χ²?=?2.201, p?=?.333 by genotypic, χ²?=?0.524, p?=?.469, OR?=?0.932, 95%CI?=?0.771–1.128 by allelic), significant differences in the genotypic frequencies were investigated between mild PE group (χ²?=?6.999, p?=?.030) or late-onset PE group (χ²?=?6.197, p?=?.045) and control group. Furthermore, when dividing the mild PE patients, the late-onset PE patients and the controls into TT/CT?+?CC, TT?+?CT/CC, and TT/CC subgroups, we found statistical differences between mild PE and controls (TT/CT?+?CC:χ²?=?5.132, p?=?.023, OR?=?2.948, 95%CI?=?1.107–7.854; TT/CC:χ²?=?4.564, p?=?.033, OR?=?2.793, 95%CI?=?1.046–7.460) as well as late-onset PE and controls (TT/CT?+?CC:χ²?=?4.043, p?=?.044, OR?=?2.248, 95%CI?=?1.000–5.055). This is the first study to indicate GCLC rs17883901 polymorphism may be associated with a risk of mild PE and late-onset PE in Chinese Han women. However, additional well-designed studies with multi-ethnic and large-scale samples should be performed to validate our results.     

Effect of exercise during pregnancy to prevent gestational diabetes mellitus: a systematic review and meta-analysis

Introduction: Exercise showed some potential in preventing gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to evaluate the impact of exercise during pregnancy on gestational diabetes mellitus.

Methods: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the influence of exercise during pregnancy on gestational diabetes mellitus were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was the incidence of gestational diabetes mellitus. Meta-analysis was performed using random-effect model.

Results: Six RCTs involving 2164 patients were included in the meta-analysis. Compared with control intervention, exercise intervention was associated with significantly decreased incidence of gestational diabetes mellitus (Std. mean difference?=?0.59; 95%CI?=?0.39–.88; p?=?.01), but had no effect on gestational age at birth (Std. mean difference?=??0.03; 95%CI?=??0.12 to 0.07; p?=?.60), the number of preterm birth (OR?=?0.85; 95%CI?=?0.43–1.66; p?=?.63), glucose 2-h post-OGTT (Std. mean difference?=??1.02; 95%CI?=??2.75 to 0.71; p?=?.25), birth weight (Std. mean difference?=??0.13; 95%CI?=??0.26 to 0.01; p?=?.06), and Apgar score less than 7 (OR?=?.78; 95%CI?=?0.21–2.91; p?=?.71).

Conclusions: Compared to control intervention, exercise intervention could significantly decrease the risk of gestational diabetes mellitus, but showed no impact on gestational age at birth, preterm birth, glucose 2-h post-OGTT, birth weight, and Apgar score less than 7.     

Surgical site infection following cesarean deliveries: trends and risk factors

Objective: To identify trends and risk factors for early surgical site infection (SSI) following cesarean delivery (CD).

Methods: A population-based study comparing characteristics of women who have and have not developed post cesarean SSI was conducted. Deliveries occurred between the years 1988 and 2013 in a tertiary medical center. A multivariable logistic regression model, with backwards elimination, was used to control for confounders.

Results: Of the 41 375 cesarean deliveries performed during the study period, 1521 (3.7%) were complicated with SSI. SSI rates significantly deceased over the years, from 7.4% in 1988 to 1.5% in 2012. Using a multivariable regression model, the following independent risk factors for SSI were identified: obesity (OR 2.0; 95% CI, 1.6–2.5); previous CD (OR 1.8; 95% CI, 1.6–2.0); hypertensive disorders (OR 1.4; 95% CI, 1.2–1.6); premature rupture of membranes (OR 1.3; 95% CI, 1.1–1.6); gestational diabetes mellitus (GDM, OR 1.2; 95% CI, 1.1–1.4); and recurrent pregnancy losses (OR 1.2; 95% CI, 1.1–1.5).

Conclusion: Independent risk factors for post-cesarean SSI include obesity, GDM, hypertensive disorders of pregnancy, premature rupture of membranes, and recurrent pregnancy losses. Information regarding higher rates of SSI and preventative measures should be provided to these high-risk women prior to surgery.     

Birth place preferences and women’s expectations and experiences regarding duration and pain of labor

Introduction: We know a great deal about how childbirth is affected by setting; we know less about how the experience of birth is shaped by the attitudes women bring with them to the birthing room. In order to better understand how women frame childbirth, we examined the relationship between birth place preference and expectations and experiences regarding duration of labor and labor pain in healthy nulliparous women.

Methods: A prospective cohort study (2007–2011) of 454 women who preferred a home birth (n?=?179), a midwife-led hospital birth (n?=?133) or an obstetrician-led hospital birth (n?=?142) in the Netherlands. Data were collected using three questionnaires (before 20 weeks gestation, 32 weeks gestation and 6 weeks postpartum) and medical records. Analyses were performed according to the initial preferred place of birth.

Results: Women who preferred a home birth were significantly less likely to be worried about the duration of labor (OR 0.5, 95%CI 0.2–0.9) and were less likely to expect difficulties with coping with pain (OR 0.4, 95%CI 0.2–0.8) compared with women who preferred an obstetrician-led birth. We found no significant differences in postpartum accounts of duration of labor. When compared to women who preferred an obstetrician-led birth, women who preferred a home birth were significantly less likely to experience labor pain as unpleasant (OR 0.3, 95%CI 0.1–0.7). Women who preferred a midwife-led birth – either home or hospital – were more likely to report that it was not possible to make their own choices regarding pain relief compared to women who preferred obstetrician-led care (OR 4.3, 95%CI 1.9–9.8 resp. 3.4, 95%CI 1.5–7.7). Compared to women who preferred a midwife-led hospital birth, women who preferred a home birth had an increased likelihood of being dissatisfied about the management of pain relief (OR 2.5, 95%CI 1.1–6.0).

Discussion: Our findings suggest a more natural orientation toward birth with the acceptance of labor pain as part of giving birth in women with a preference for a home birth. Knowledge about women’s expectations and experiences will help caregivers to prepare women for childbirth and will equip them to advise women on birth settings that fit their cognitive frame.     

Induction of labor in cases of late preterm isolated oligohydramnios: is it justified?

Objectives: To analyze in a retrospective cohort study the outcomes of pregnancies with isolated oligohydramnios at the late preterm period (34–36.6 weeks of gestation).

Study design: This retrospective cohort study included three groups of women: (1) Women with isolated oligohydramnios whose pregnancy was managed conservatively (n?=?33 births); (2) women with isolated oligohydramnios who were managed actively (i.e. induction of labor) (n?=?111 births); and (3) a control group including women with normal amount of amniotic fluid who had a spontaneous late preterm delivery (n?=?10,445 births). Maternal and fetal characteristics and obstetrics outcomes were collected from a computerized database of all deliveries at Soroka University Medical Center during the study period.

Results: Our cohort included 10,589 births. The rate of inducing labor was higher in the oligohydramnios groups compared to the controls (p?p?p?=?.026), chorioamnionitis (p?=?.01), and transitory tachypnea of the newborn (p?=?.02). After controlling for confounding factors, mal presentation (OR?=?19.9), and a prior CS (OR?=?2.4) were independently associated with an increased risk for CS, while induction of labor was associated with a reduced risk for CS (OR?=?0.28).

Conclusions: Women with late preterm isolated oligohydramnios had a higher rate of induction of labor than women with a normal amount of amniotic fluid. Induction of labor seems to be beneficial to both the neonate and the mother as seen by a lower rate of CS conducted in this group, as well as lower maternal and neonatal morbidity in comparison to the conservative group. Therefore, women with oligohydramnios at late preterm may benefit from induction of labor.     

Timing of antibiotic prophylaxis in cesarean section: retrospective,difference-in-differences estimation of the effect on surgical-site-infection

Background: Cesarean section (CS) is one of the most common surgical procedures performed worldwide. Surgical-site-infection (SSI) occurs in approximately 5–10% of CS. The benefit of prophylactic antibiotics for prevention of SSI has been demonstrated in the literature. The optimal timing of antibiotic prophylaxis (prior to surgical incision versus after cord clamping) was investigated in recent studies. In January 2014, the Israeli Ministry of Health introduced a national quality measure which monitors the administration of prophylactic antibiotics in CS. The custom clinical practice in our medical center was to administer prophylactic antibiotics immediately after cord clamping. Upon introduction of the national quality measurement program, the practice was changed to administration of antibiotics prior to surgical incision. Our objective was to examine the effect of timing of prophylactic antibiotics administration on the incidence of SSI following CS, in a single medical center that performs a large volume of deliveries, with a low rate of CS.

Material and methods: Taking advantage of a discrete change in clinical practice, we used retrospective data and applied difference-in-differences design to estimate the effect of the timing of prophylactic antibiotics administration on SSI rates. The analysis included all CSs performed during 2012–2015 and all hysterectomies conducted during the study period.

Results: The coverage rates of prophylactic antibiotics in CS before and after the policy change were 99.10% and 99.03%, respectively. The rates of SSI following CS, before and after the policy change, were 2.63% (n?=?2499) and 2.32% (n?=?3840), respectively. The rates of SSI following hysterectomy, before and after the policy, change were 6.82% (n?=?396) and 7.09% (n?=?437), respectively. Difference-in-differences (DID) estimates of the effect of policy change on the incidence of SSI in linear and logistic regression models were not significant (B?=??0.6%, p?=?.64; odds ratio?=?0.84, p?=?.58, respectively).

Conclusions: We found no effect of the timing of prophylactic antibiotic administration (prior to surgical incision versus after cord clamping) on SSI rates following CS.     

Relationship between Doppler findings and fetal brain apparent diffusion coefficient in early-onset intra-uterine growth restriction*

Objective: The aim of the study is to assess the relationship between uteroplacental Doppler sonography findings and cerebral diffusion measured by diffusion-weighted magnetic resonance imaging (DWI) in fetuses with early-onset intrauterine growth restriction (IUGR).

Materials and methods: The study included 54 pregnant women with fetal IUGR and 15 healthy controls (n: 15). Fetuses with IUGR were classified into four groups based on Doppler findings: group 1 (n?=?12), umbilical artery (UA) pulsatility index (PI)?>?95pc; group 2 (n?=?11), UA PI >95?pc and middle cerebral artery PI?n?=?21), absent end-diastolic (A-EDF) in UA; group 4 (n?=?10), reversed EDF in UA. After Doppler evaluation, DWI was performed in all patients within hours. The groups were compared with respect to apparent diffusion coefficient (ADC) levels.

Findings: In cases with fetal IUGR, significant decreases were detected in ADC values of periatrial white matter (PAWM) (p?=?.01), frontal white matter (FWM) (p?=?.038), thalamus (p?=?.004), and basal ganglia (p?=?.013) compared to controls. In Doppler subgroup analysis adjusted for gestational age, ADC values of FWM, thalami, and pons were significantly lower in group 4 than control group (p?=?.02, p?=?.02, and p?=?.037, respectively). In PAWM, ADC values were significantly lower in group 4 than control and Group 1 (p?=?.004). No significant differences with regard to ADC values in basal ganglia, cerebellum was found between Doppler groups and control.

Conclusions: In fetuses with IUGR, ADC values as measured by DWI decreases. The critical Doppler finding that is associated with reduced diffusion in some brain areas (FWM, PAWM, thalami, pons) is reverse end-diastolic flow in umbilical artery. Further prospective studies with larger sample size are needed to introduce cerebral ADC values in the management of IUGR     

Is there a role for kisspeptin in pathogenesis of polycystic ovary syndrome?

Aim: To investigate association of kisspeptin levels in infertile women with different ovarian reserve patterns.

Materials and methods: In this prospective cross-sectional study, 157 participants were recruited. The women were divided into three groups: (i) adequate ovarian reserve (AOR) (n?=?57), (ii) high ovarian reserve (PCOS) (n?=?60), (iii) diminished ovarian reserve (DOR) (n?=?40). Weight, height, waist circumference (WC), hip circumference (HC), body mass index (BMI), waist/hip ratio (WHR) were measured. The blood samples were analyzed for estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), 17-hydroxy progesterone (17OHP), dehydroepiandrosterone sulfate (DHEAS), antimullerian hormone (AMH), kisspeptin measurements.

Results: FSH concentration was higher and AMH concentration was lower in DOR group (p?p?p?=?.001, p?p?=?.003, respectively). The 17OHP level did not differ among the groups (p?=?.15). Women with PCOS possessed the highest kisspeptin level (p?=?.01). The kisspeptin level was negatively correlated with FSH level (r?=??0.18, p?=?.02) and positively correlated with TT and DHEAS levels (r?=?0.17, p?=?.02 and r?=?0.23, p?=?.003, respectively).

Conclusions: Women with PCOS had increased serum kisspeptin levels. Kisspeptin concentrations were negatively correlated with serum FSH and positively correlated with serum TT and DHEAS levels.