Uriel Elchalal - Academia.edu (original) (raw)
Papers by Uriel Elchalal
rial or venous thrombosis, recurrent fetal loss, moderate thrombocytopenia, and the presence of a... more rial or venous thrombosis, recurrent fetal loss, moderate thrombocytopenia, and the presence of antiphospholipid antibodies. Classification criteria for catastrophic APS were recently defined, as follows: evidence of involvement of three or more organs, systems, and/or tissues; development of manifestations simultaneously or in less than a week with histopathologic evidence of vascular occlusion; and laboratory confirmation of the presence of antiphospholipid antibodies [1]. Catastrophic APS may also appear in pregnant women, presenting with thrombotic events including liver infarcts and fetal loss, as well as thrombocytopenia. This condition is often labeled as “HELLP-like syndrome.” HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) is a thrombotic microangiopathic vasculopathy presenting in pregnancy, which has some features similar to catastrophic APS. We present a 37 year old woman with catastrophic APS who developed multiple hepatic infarcts, thrombocytopenia...
Cytotherapy
BACKGROUND AIMS Human umbilical cord blood (HUCB) is an important source of stem cells for therap... more BACKGROUND AIMS Human umbilical cord blood (HUCB) is an important source of stem cells for therapy of hematopoietic disorders and is a potential therapy for various neurological disorders, including traumatic brain injury (TBI). The expression of nerve growth factor (NGF) and its receptors TrkA, p75NTR and α9β1 integrin on an HUCB CD45+ pan-hematopoietic subpopulation was investigated in the context of its neurotherapeutic potential after TBI. METHODS NGF and its receptors were detected on CD45+ cells by reverse transcriptase polymerase chain reaction, flow cytometry analysis and confocal microscopy. CD45+ cells were stimulated by TBI brain extracts, and NGF levels were measured by enzyme-linked immunosorbent assay. TBI mice were divided into six groups for xenogeneic intravenous transplantation, 1 day post-trauma, with 1 × 106 CD45+ cells untreated or treated with the anti-NGF neutralizing antibody K252a, a TrkA antagonist; VLO5, an α9β1 disintegrin; or negative (vehicle) and positive (NGF) controls. RESULTS The HUCB CD45+ subpopulation constitutively expresses NGF and its receptors, mainly TrkA and p75NTR and minor levels of α9β1. In vitro experiments provided evidence that trauma-related mediators from brain extracts of TBI mice induced release of NGF from HUCB CD45+ cell cultures. HUCB CD45+ cells induced a neurotherapeutic effect in TBI mice, abrogated by cell treatment with either anti-NGF antibody or K252a, but not VLO5. CONCLUSIONS These findings strengthen the role of NGF and its TrkA receptor in the HUCB CD45+ subpopulation's neurotherapeutic effect. The presence of neurotrophin receptors in the HUCB CD45+ pan-hematopoietic subpopulation may explain the neuroprotective effect of cord blood in therapy of a variety of neurological disorders.
American Journal of Obstetrics and Gynecology
women and recommended to 5% of women with high-risk medical conditions or taking a teratogenic me... more women and recommended to 5% of women with high-risk medical conditions or taking a teratogenic medication. The risks of pregnancy or medication were rarely documented. CONCLUSION: While non-gynecologic specialists feel that contraceptive counseling is their responsibility, they do not routinely document counseling nor refer them to a gynecologist. OB and MFMs must provide more outreach to subspecialists who care for these women to help prevent unintended pregnancies in women at high risk of perinatal morbidity.
European Journal of Obstetrics & Gynecology and Reproductive Biology
OBJECTIVE Gestational thrombocytopenia (GT) accounts for 75% of cases of thrombocytopenia in preg... more OBJECTIVE Gestational thrombocytopenia (GT) accounts for 75% of cases of thrombocytopenia in pregnancy. In most cases of GT, thrombocytopenia is mild (100-150 × 109/L) and has no consequences for either the mother or the fetus. We aimed to investigate the characteristics, neonatal risk and recurrence rate of GT with a platelet count <100 × 109/L. STUDY DESIGN We reviewed the records of women who delivered during 2006-2016 at a large tertiary care university hospital, and who had platelet count <100 × 109/L during pregnancy. RESULTS Of 97 pregnancies in which platelet count lower than 100 × 109/L was encountered, 66 (68%) were diagnosed as GT and 31 (32%) as new-onset immune-thrombocytopenic purpura (ITP). The proportions of women with onset of thrombocytopenia in early pregnancy (P = 0.004) and a lower maternal nadir platelet count (P = 0.01) were higher among those with new-onset ITP than GT. There was no difference in the rate of neonatal thrombocytopenia (<100 × 109/L) between those with newly diagnosed ITP and GT (16.1% vs. 10.6%, P = 0.51). Among women with GT, the rate of neonatal thrombocytopenia was higher in those who experienced antepartum bleeding (P = 0.009) and in whom the onset of thrombocytopenia was in early pregnancy (P = 0.002). Of 40 subsequent pregnancies, a recurrence of GT (<100 × 109/L) was encountered in 22 (55%), with similar maternal and perinatal outcomes compared to the initial pregnancy. CONCLUSION The risk of neonatal thrombocytopenia was substantial, with no difference found between those with GT and new-onset ITP. The recurrence rate of GT was high in subsequent pregnancies.
The Journal of Maternal-Fetal & Neonatal Medicine
Abstract Objectives: To characterize the risk factors associated with neonatal thrombocytopenia a... more Abstract Objectives: To characterize the risk factors associated with neonatal thrombocytopenia among pregnant women with immune thrombocytopenic purpura (ITP). Methods: We reviewed the records of ITP patients who delivered during 2006–2016 at our medical center. Results: Of 253 pregnancies, median maternal age at diagnosis was 29 [25–33] years, 222 (87.7%) had previously-diagnosed ITP and 31 (12.3%) were diagnosed with new-onset ITP during pregnancy. Baseline characteristics were comparable between the groups except for a higher proportion of nulliparity among those with new-onset disease (p = .002). Maternal nadir platelet count was significantly lower among those with new-onset compared to previously diagnosed ITP (median 62 × 109/L versus 81 × 109/L, p = .005). Neonatal thrombocytopenia (<150 × 109/L) was encountered in 24 (9.5%) pregnancies and required treatment in 12 (50%) of them. Neonatal platelet count was directly correlated with maternal platelet count at delivery (r = 0.23, p = .01), with significantly lower maternal platelet count among those whose newborns experienced thrombocytopenia (p < .001). Neonatal thrombocytopenia followed a higher proportion of pregnancies of women with new-onset than previously diagnosed ITP (22.6 versus 7.7%, p = .02). In multivariate analysis, the presence of new-onset ITP (odds ratio [95% CI]: 4.88 (1.68, 14.16), p = .004) was the only independent predictor of the development of neonatal thrombocytopenia. Conclusion: Neonatal thrombocytopenia presented following almost one-tenth of pregnancies with ITP. New pregnancy-onset disease was the only prognostic marker for neonatal thrombocytopenia. This finding could contribute to risk stratification and individualized patient management.
Screening, diagnosis and classification Gestational diabetes mellitus is defined as glucose intol... more Screening, diagnosis and classification Gestational diabetes mellitus is defined as glucose intolerance that is first detected during pregnancy [1]. Depending on the ethnic group and diagnostic criteria of the population studied, the occurrence of gestational diabetes ranges between 1.4% and 14.0% [2]. Although evidence suggests that even mild maternal hyperglycemia increases fetal morbidity, it occurs only in a minority of cases, rendering routine GDM screening questionable [3]. In contrast, failure to recognize GDM might result in greater fetal or maternal morbidity. Because GDM is usually asymptomatic, we have to rely on various screening programs to select patients for the 3 hour diagnostic oral glucose tolerance test (100 g). In 1998 the fourth international workshop-conference on gestational diabetes [1] recommended universal GDM screening of all pregnant women, using the 50 g glucose challenge test at 24±28 weeks gestational age. A cutoff of 140 mg/dl (7.8 mmol/L) on the GCT ...
European Journal of Obstetrics & Gynecology and Reproductive Biology
American Journal of Obstetrics and Gynecology
American Journal of Obstetrics and Gynecology
5.3% % (p< 0.001) between 2013 and 2017. Deliveries of women with PIH rose by 73% from 3.7% to 6.... more 5.3% % (p< 0.001) between 2013 and 2017. Deliveries of women with PIH rose by 73% from 3.7% to 6.4% % (p< 0.001) between 2013 and 2017. Deliveries of women with diabetes rose by 121.1% from 3.3% to 7.3 % (p< 0.001) between 2013 and 2017. CONCLUSION: We demonstrate a significant increase in all of the maternal risk factors that were studied among US births during 2003-2017. Although the increase in grand multiparity and advanced maternal age >40 was moderate, there has been a dramatic increase in the risk of PIH and DM suggesting additional contributing factors.
Placenta
We evaluated changes in placental and fetal hemodynamics in rodents during acute hypercapnia usin... more We evaluated changes in placental and fetal hemodynamics in rodents during acute hypercapnia using BOLD-MRI and Doppler ultrasound. Animals were anesthetized with pentobarbital and, in consecutive 4-min periods, breathed: air, 21%O2:5%CO2, and 95%O2:5%CO2. Pregnant ICR mice (n = 6; E17.5) were scanned in a 4.7-T Bruker Biospec spectrometer. Placenta and fetal liver, heart and brain were identified on True-FISP images. Percent change in signal intensity (SI) were analyzed every 30 s from T2*-weighted GE images (TR/TE = 147/10 ms). Doppler: Pregnant Wistar rats (n = 6; E18-20) were anesthetized with pentobarbital and received abdominal Doppler ultrasound. Umbilical artery pulsatility index (PI) and fetal heart rate were assessed at baseline and after two minutes of both hypercapnic challenges. BOLD-MRI: Normoxic-hypercapnia caused immediate marked reduction in SI in placenta (-44% ± 5.5; p < 0.001), fetal liver (-32% ± 6.4; p < 0.001) and fetal heart (-53% ± 9.9; p < 0.001) but only minor changes in fetal brain (-13% ± 3.4; p < 0.01), suggesting fetal brain sparing. Doppler: Normoxic-hypercapnia caused a marked increase in umbilical artery PI (+27.4% ± 7.2; p < 0.001) and a reduction in fetal heart rate (-48 bpm; 95%CI -9.3 to -87.0; p = 0.02), suggesting acute fetal asphyxia. Brief maternal hypercapnic challenge caused BOLD-MRI changes consistent with acute placental and fetal hypoperfusion with fetal brain sparing. The same challenge caused increased umbilical artery PI and fetal bradycardia on Doppler ultrasound, suggestive for acute fetal asphyxia. BOLD-MRI may be a suitable noninvasive imaging strategy to assess placental and fetal organ hemodynamics.
Surgery for Obesity and Related Diseases
The Journal of Maternal-Fetal & Neonatal Medicine
American Journal of Obstetrics and Gynecology
women and recommended to 5% of women with high-risk medical conditions or taking a teratogenic me... more women and recommended to 5% of women with high-risk medical conditions or taking a teratogenic medication. The risks of pregnancy or medication were rarely documented. CONCLUSION: While non-gynecologic specialists feel that contraceptive counseling is their responsibility, they do not routinely document counseling nor refer them to a gynecologist. OB and MFMs must provide more outreach to subspecialists who care for these women to help prevent unintended pregnancies in women at high risk of perinatal morbidity.
Surgery for Obesity and Related Diseases
Acta Obstetricia et Gynecologica Scandinavica
Introduction: Previous reports have shown that suboptimal antenatal corticosteroids administratio... more Introduction: Previous reports have shown that suboptimal antenatal corticosteroids administration occurs in most cases. However, as multifetal gestations were either excluded or constituted a small proportion of the participants in these studies, little is known about the patterns of use of antenatal corticosteroids in twin pregnancies. Material and methods: We reviewed the records of women who received antenatal corticosteroids and delivered between 24 0/7 and 34 6/7 weeks of gestation during 2015-2017 at 2 university hospitals. Optimal antenatal corticosteroids timing was defined as delivery ≥24 hours ≤7 days from the previous antenatal corticosteroids course. Results: Of 424 pregnancies, 307 (72.4%) were singleton and 117 were (27.6%) twin. For twin compared with singleton pregnancies, gestational age at initial antenatal corticosteroids administration was lower (P = 0.02), the proportion of deliveries within the optimal window of the initial antenatal corticosteroids course was lower (19.7% vs 33.2%, P = 0.001), and the proportion of women eligible for a rescue antenatal corticosteroids course was higher (58.1% vs 32.9%, P < 0.0001). However, despite similar rates of rescue antenatal corticosteroids administration (P = 0.64), the overall rate of delivery within any optimal window (either initial or rescue course) was lower in twin than singleton pregnancies (26.5% vs 42.3%, P = 0.004), and the antenatal corticosteroids-to-delivery interval was longer (median 6.9 vs 4.2 days, P = 0.0009). In multivariate analysis, optimal antenatal corticosteroids administration was negatively associated with twin pregnancy (P = 0.04) and preterm labor (P = 0.05), and positively associated with the presence of gestational hypertensive disorders (P = 0.03). Conclusions: Twin pregnancy is an independent risk factor for suboptimal antenatal corticosteroids administration. Directed efforts should be made to improve the utilization of antenatal corticosteroids in this vulnerable group of women.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 10, 2018
Herein, we describe the first case of mammary implant infection caused by Coxiella burnetii, resu... more Herein, we describe the first case of mammary implant infection caused by Coxiella burnetii, resulting in delayed diagnosis and treatment and an in-hospital cross-transmission of Q fever to medical personnel.
Israel journal of health policy research, Jan 19, 2018
Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary a... more Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary antenatal management. In the current study we describe women with concurrent medical conditions who attended our antenatal anesthesia clinic over a 14-year period, 2002-2015 and, based on the findings, we suggest new policies, strategies and practices to improve antenatal care. In 2002, an antenatal anesthesia clinic was established in Hadassah Medical Center. Each consultation focused on the concurrent medical condition. A written anesthesia strategy according to the medical condition and its anesthesia considerations was discussed and given to the patient. Data regarding clinic visits were recorded. A total of 451 clinic women attended the antenatal anesthesia clinic. Maternal age was 31.7 ± 6.0 years (mean ± SD), with gestational age of pregnancy 33.0 ± 5.4 weeks at the clinic visit. Musculoskeletal conditions (23% of all the women seen) were the most frequent concurrent conditions, fo...
Placenta
We evaluated changes in placental and fetal hemodynamics in rodents during acute hypercapnia usin... more We evaluated changes in placental and fetal hemodynamics in rodents during acute hypercapnia using BOLD-MRI and Doppler ultrasound. Animals were anesthetized with pentobarbital and, in consecutive 4-min periods, breathed: air, 21%O2:5%CO2, and 95%O2:5%CO2. Pregnant ICR mice (n = 6; E17.5) were scanned in a 4.7-T Bruker Biospec spectrometer. Placenta and fetal liver, heart and brain were identified on True-FISP images. Percent change in signal intensity (SI) were analyzed every 30 s from T2*-weighted GE images (TR/TE = 147/10 ms). Doppler: Pregnant Wistar rats (n = 6; E18-20) were anesthetized with pentobarbital and received abdominal Doppler ultrasound. Umbilical artery pulsatility index (PI) and fetal heart rate were assessed at baseline and after two minutes of both hypercapnic challenges. BOLD-MRI: Normoxic-hypercapnia caused immediate marked reduction in SI in placenta (-44% ± 5.5; p < 0.001), fetal liver (-32% ± 6.4; p < 0.001) and fetal heart (-53% ± 9.9; p < 0.001) but only minor changes in fetal brain (-13% ± 3.4; p < 0.01), suggesting fetal brain sparing. Doppler: Normoxic-hypercapnia caused a marked increase in umbilical artery PI (+27.4% ± 7.2; p < 0.001) and a reduction in fetal heart rate (-48 bpm; 95%CI -9.3 to -87.0; p = 0.02), suggesting acute fetal asphyxia. Brief maternal hypercapnic challenge caused BOLD-MRI changes consistent with acute placental and fetal hypoperfusion with fetal brain sparing. The same challenge caused increased umbilical artery PI and fetal bradycardia on Doppler ultrasound, suggestive for acute fetal asphyxia. BOLD-MRI may be a suitable noninvasive imaging strategy to assess placental and fetal organ hemodynamics.
BMC medical education, Jan 18, 2017
During their final year of medical school, Israeli students must consider which specialty to choo... more During their final year of medical school, Israeli students must consider which specialty to choose for residency. Based on the vocational counseling literature we presumed that choices are made by selecting from a cluster of related specialties while considering professional and socio-economic issues. Questionnaires distributed to final-year medical students at two Israeli medical schools ascertained inclinations toward various medical specialties and the importance of various selection criteria. Analysis focused on seven specialties where >20% of students reported they had positive inclinations. For each such specialty, the specialty and selection criteria query were compared using unpaired two-tailed Student's t-tests to determine differences between students with positive inclinations toward the specialty with those not so inclined. These data were placed in tables, with the significant differences highlighted to facilitate visual recognition of cluster patterns. Complete...
rial or venous thrombosis, recurrent fetal loss, moderate thrombocytopenia, and the presence of a... more rial or venous thrombosis, recurrent fetal loss, moderate thrombocytopenia, and the presence of antiphospholipid antibodies. Classification criteria for catastrophic APS were recently defined, as follows: evidence of involvement of three or more organs, systems, and/or tissues; development of manifestations simultaneously or in less than a week with histopathologic evidence of vascular occlusion; and laboratory confirmation of the presence of antiphospholipid antibodies [1]. Catastrophic APS may also appear in pregnant women, presenting with thrombotic events including liver infarcts and fetal loss, as well as thrombocytopenia. This condition is often labeled as “HELLP-like syndrome.” HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) is a thrombotic microangiopathic vasculopathy presenting in pregnancy, which has some features similar to catastrophic APS. We present a 37 year old woman with catastrophic APS who developed multiple hepatic infarcts, thrombocytopenia...
Cytotherapy
BACKGROUND AIMS Human umbilical cord blood (HUCB) is an important source of stem cells for therap... more BACKGROUND AIMS Human umbilical cord blood (HUCB) is an important source of stem cells for therapy of hematopoietic disorders and is a potential therapy for various neurological disorders, including traumatic brain injury (TBI). The expression of nerve growth factor (NGF) and its receptors TrkA, p75NTR and α9β1 integrin on an HUCB CD45+ pan-hematopoietic subpopulation was investigated in the context of its neurotherapeutic potential after TBI. METHODS NGF and its receptors were detected on CD45+ cells by reverse transcriptase polymerase chain reaction, flow cytometry analysis and confocal microscopy. CD45+ cells were stimulated by TBI brain extracts, and NGF levels were measured by enzyme-linked immunosorbent assay. TBI mice were divided into six groups for xenogeneic intravenous transplantation, 1 day post-trauma, with 1 × 106 CD45+ cells untreated or treated with the anti-NGF neutralizing antibody K252a, a TrkA antagonist; VLO5, an α9β1 disintegrin; or negative (vehicle) and positive (NGF) controls. RESULTS The HUCB CD45+ subpopulation constitutively expresses NGF and its receptors, mainly TrkA and p75NTR and minor levels of α9β1. In vitro experiments provided evidence that trauma-related mediators from brain extracts of TBI mice induced release of NGF from HUCB CD45+ cell cultures. HUCB CD45+ cells induced a neurotherapeutic effect in TBI mice, abrogated by cell treatment with either anti-NGF antibody or K252a, but not VLO5. CONCLUSIONS These findings strengthen the role of NGF and its TrkA receptor in the HUCB CD45+ subpopulation's neurotherapeutic effect. The presence of neurotrophin receptors in the HUCB CD45+ pan-hematopoietic subpopulation may explain the neuroprotective effect of cord blood in therapy of a variety of neurological disorders.
American Journal of Obstetrics and Gynecology
women and recommended to 5% of women with high-risk medical conditions or taking a teratogenic me... more women and recommended to 5% of women with high-risk medical conditions or taking a teratogenic medication. The risks of pregnancy or medication were rarely documented. CONCLUSION: While non-gynecologic specialists feel that contraceptive counseling is their responsibility, they do not routinely document counseling nor refer them to a gynecologist. OB and MFMs must provide more outreach to subspecialists who care for these women to help prevent unintended pregnancies in women at high risk of perinatal morbidity.
European Journal of Obstetrics & Gynecology and Reproductive Biology
OBJECTIVE Gestational thrombocytopenia (GT) accounts for 75% of cases of thrombocytopenia in preg... more OBJECTIVE Gestational thrombocytopenia (GT) accounts for 75% of cases of thrombocytopenia in pregnancy. In most cases of GT, thrombocytopenia is mild (100-150 × 109/L) and has no consequences for either the mother or the fetus. We aimed to investigate the characteristics, neonatal risk and recurrence rate of GT with a platelet count <100 × 109/L. STUDY DESIGN We reviewed the records of women who delivered during 2006-2016 at a large tertiary care university hospital, and who had platelet count <100 × 109/L during pregnancy. RESULTS Of 97 pregnancies in which platelet count lower than 100 × 109/L was encountered, 66 (68%) were diagnosed as GT and 31 (32%) as new-onset immune-thrombocytopenic purpura (ITP). The proportions of women with onset of thrombocytopenia in early pregnancy (P = 0.004) and a lower maternal nadir platelet count (P = 0.01) were higher among those with new-onset ITP than GT. There was no difference in the rate of neonatal thrombocytopenia (<100 × 109/L) between those with newly diagnosed ITP and GT (16.1% vs. 10.6%, P = 0.51). Among women with GT, the rate of neonatal thrombocytopenia was higher in those who experienced antepartum bleeding (P = 0.009) and in whom the onset of thrombocytopenia was in early pregnancy (P = 0.002). Of 40 subsequent pregnancies, a recurrence of GT (<100 × 109/L) was encountered in 22 (55%), with similar maternal and perinatal outcomes compared to the initial pregnancy. CONCLUSION The risk of neonatal thrombocytopenia was substantial, with no difference found between those with GT and new-onset ITP. The recurrence rate of GT was high in subsequent pregnancies.
The Journal of Maternal-Fetal & Neonatal Medicine
Abstract Objectives: To characterize the risk factors associated with neonatal thrombocytopenia a... more Abstract Objectives: To characterize the risk factors associated with neonatal thrombocytopenia among pregnant women with immune thrombocytopenic purpura (ITP). Methods: We reviewed the records of ITP patients who delivered during 2006–2016 at our medical center. Results: Of 253 pregnancies, median maternal age at diagnosis was 29 [25–33] years, 222 (87.7%) had previously-diagnosed ITP and 31 (12.3%) were diagnosed with new-onset ITP during pregnancy. Baseline characteristics were comparable between the groups except for a higher proportion of nulliparity among those with new-onset disease (p = .002). Maternal nadir platelet count was significantly lower among those with new-onset compared to previously diagnosed ITP (median 62 × 109/L versus 81 × 109/L, p = .005). Neonatal thrombocytopenia (<150 × 109/L) was encountered in 24 (9.5%) pregnancies and required treatment in 12 (50%) of them. Neonatal platelet count was directly correlated with maternal platelet count at delivery (r = 0.23, p = .01), with significantly lower maternal platelet count among those whose newborns experienced thrombocytopenia (p < .001). Neonatal thrombocytopenia followed a higher proportion of pregnancies of women with new-onset than previously diagnosed ITP (22.6 versus 7.7%, p = .02). In multivariate analysis, the presence of new-onset ITP (odds ratio [95% CI]: 4.88 (1.68, 14.16), p = .004) was the only independent predictor of the development of neonatal thrombocytopenia. Conclusion: Neonatal thrombocytopenia presented following almost one-tenth of pregnancies with ITP. New pregnancy-onset disease was the only prognostic marker for neonatal thrombocytopenia. This finding could contribute to risk stratification and individualized patient management.
Screening, diagnosis and classification Gestational diabetes mellitus is defined as glucose intol... more Screening, diagnosis and classification Gestational diabetes mellitus is defined as glucose intolerance that is first detected during pregnancy [1]. Depending on the ethnic group and diagnostic criteria of the population studied, the occurrence of gestational diabetes ranges between 1.4% and 14.0% [2]. Although evidence suggests that even mild maternal hyperglycemia increases fetal morbidity, it occurs only in a minority of cases, rendering routine GDM screening questionable [3]. In contrast, failure to recognize GDM might result in greater fetal or maternal morbidity. Because GDM is usually asymptomatic, we have to rely on various screening programs to select patients for the 3 hour diagnostic oral glucose tolerance test (100 g). In 1998 the fourth international workshop-conference on gestational diabetes [1] recommended universal GDM screening of all pregnant women, using the 50 g glucose challenge test at 24±28 weeks gestational age. A cutoff of 140 mg/dl (7.8 mmol/L) on the GCT ...
European Journal of Obstetrics & Gynecology and Reproductive Biology
American Journal of Obstetrics and Gynecology
American Journal of Obstetrics and Gynecology
5.3% % (p< 0.001) between 2013 and 2017. Deliveries of women with PIH rose by 73% from 3.7% to 6.... more 5.3% % (p< 0.001) between 2013 and 2017. Deliveries of women with PIH rose by 73% from 3.7% to 6.4% % (p< 0.001) between 2013 and 2017. Deliveries of women with diabetes rose by 121.1% from 3.3% to 7.3 % (p< 0.001) between 2013 and 2017. CONCLUSION: We demonstrate a significant increase in all of the maternal risk factors that were studied among US births during 2003-2017. Although the increase in grand multiparity and advanced maternal age >40 was moderate, there has been a dramatic increase in the risk of PIH and DM suggesting additional contributing factors.
Placenta
We evaluated changes in placental and fetal hemodynamics in rodents during acute hypercapnia usin... more We evaluated changes in placental and fetal hemodynamics in rodents during acute hypercapnia using BOLD-MRI and Doppler ultrasound. Animals were anesthetized with pentobarbital and, in consecutive 4-min periods, breathed: air, 21%O2:5%CO2, and 95%O2:5%CO2. Pregnant ICR mice (n = 6; E17.5) were scanned in a 4.7-T Bruker Biospec spectrometer. Placenta and fetal liver, heart and brain were identified on True-FISP images. Percent change in signal intensity (SI) were analyzed every 30 s from T2*-weighted GE images (TR/TE = 147/10 ms). Doppler: Pregnant Wistar rats (n = 6; E18-20) were anesthetized with pentobarbital and received abdominal Doppler ultrasound. Umbilical artery pulsatility index (PI) and fetal heart rate were assessed at baseline and after two minutes of both hypercapnic challenges. BOLD-MRI: Normoxic-hypercapnia caused immediate marked reduction in SI in placenta (-44% ± 5.5; p < 0.001), fetal liver (-32% ± 6.4; p < 0.001) and fetal heart (-53% ± 9.9; p < 0.001) but only minor changes in fetal brain (-13% ± 3.4; p < 0.01), suggesting fetal brain sparing. Doppler: Normoxic-hypercapnia caused a marked increase in umbilical artery PI (+27.4% ± 7.2; p < 0.001) and a reduction in fetal heart rate (-48 bpm; 95%CI -9.3 to -87.0; p = 0.02), suggesting acute fetal asphyxia. Brief maternal hypercapnic challenge caused BOLD-MRI changes consistent with acute placental and fetal hypoperfusion with fetal brain sparing. The same challenge caused increased umbilical artery PI and fetal bradycardia on Doppler ultrasound, suggestive for acute fetal asphyxia. BOLD-MRI may be a suitable noninvasive imaging strategy to assess placental and fetal organ hemodynamics.
Surgery for Obesity and Related Diseases
The Journal of Maternal-Fetal & Neonatal Medicine
American Journal of Obstetrics and Gynecology
women and recommended to 5% of women with high-risk medical conditions or taking a teratogenic me... more women and recommended to 5% of women with high-risk medical conditions or taking a teratogenic medication. The risks of pregnancy or medication were rarely documented. CONCLUSION: While non-gynecologic specialists feel that contraceptive counseling is their responsibility, they do not routinely document counseling nor refer them to a gynecologist. OB and MFMs must provide more outreach to subspecialists who care for these women to help prevent unintended pregnancies in women at high risk of perinatal morbidity.
Surgery for Obesity and Related Diseases
Acta Obstetricia et Gynecologica Scandinavica
Introduction: Previous reports have shown that suboptimal antenatal corticosteroids administratio... more Introduction: Previous reports have shown that suboptimal antenatal corticosteroids administration occurs in most cases. However, as multifetal gestations were either excluded or constituted a small proportion of the participants in these studies, little is known about the patterns of use of antenatal corticosteroids in twin pregnancies. Material and methods: We reviewed the records of women who received antenatal corticosteroids and delivered between 24 0/7 and 34 6/7 weeks of gestation during 2015-2017 at 2 university hospitals. Optimal antenatal corticosteroids timing was defined as delivery ≥24 hours ≤7 days from the previous antenatal corticosteroids course. Results: Of 424 pregnancies, 307 (72.4%) were singleton and 117 were (27.6%) twin. For twin compared with singleton pregnancies, gestational age at initial antenatal corticosteroids administration was lower (P = 0.02), the proportion of deliveries within the optimal window of the initial antenatal corticosteroids course was lower (19.7% vs 33.2%, P = 0.001), and the proportion of women eligible for a rescue antenatal corticosteroids course was higher (58.1% vs 32.9%, P < 0.0001). However, despite similar rates of rescue antenatal corticosteroids administration (P = 0.64), the overall rate of delivery within any optimal window (either initial or rescue course) was lower in twin than singleton pregnancies (26.5% vs 42.3%, P = 0.004), and the antenatal corticosteroids-to-delivery interval was longer (median 6.9 vs 4.2 days, P = 0.0009). In multivariate analysis, optimal antenatal corticosteroids administration was negatively associated with twin pregnancy (P = 0.04) and preterm labor (P = 0.05), and positively associated with the presence of gestational hypertensive disorders (P = 0.03). Conclusions: Twin pregnancy is an independent risk factor for suboptimal antenatal corticosteroids administration. Directed efforts should be made to improve the utilization of antenatal corticosteroids in this vulnerable group of women.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 10, 2018
Herein, we describe the first case of mammary implant infection caused by Coxiella burnetii, resu... more Herein, we describe the first case of mammary implant infection caused by Coxiella burnetii, resulting in delayed diagnosis and treatment and an in-hospital cross-transmission of Q fever to medical personnel.
Israel journal of health policy research, Jan 19, 2018
Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary a... more Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary antenatal management. In the current study we describe women with concurrent medical conditions who attended our antenatal anesthesia clinic over a 14-year period, 2002-2015 and, based on the findings, we suggest new policies, strategies and practices to improve antenatal care. In 2002, an antenatal anesthesia clinic was established in Hadassah Medical Center. Each consultation focused on the concurrent medical condition. A written anesthesia strategy according to the medical condition and its anesthesia considerations was discussed and given to the patient. Data regarding clinic visits were recorded. A total of 451 clinic women attended the antenatal anesthesia clinic. Maternal age was 31.7 ± 6.0 years (mean ± SD), with gestational age of pregnancy 33.0 ± 5.4 weeks at the clinic visit. Musculoskeletal conditions (23% of all the women seen) were the most frequent concurrent conditions, fo...
Placenta
We evaluated changes in placental and fetal hemodynamics in rodents during acute hypercapnia usin... more We evaluated changes in placental and fetal hemodynamics in rodents during acute hypercapnia using BOLD-MRI and Doppler ultrasound. Animals were anesthetized with pentobarbital and, in consecutive 4-min periods, breathed: air, 21%O2:5%CO2, and 95%O2:5%CO2. Pregnant ICR mice (n = 6; E17.5) were scanned in a 4.7-T Bruker Biospec spectrometer. Placenta and fetal liver, heart and brain were identified on True-FISP images. Percent change in signal intensity (SI) were analyzed every 30 s from T2*-weighted GE images (TR/TE = 147/10 ms). Doppler: Pregnant Wistar rats (n = 6; E18-20) were anesthetized with pentobarbital and received abdominal Doppler ultrasound. Umbilical artery pulsatility index (PI) and fetal heart rate were assessed at baseline and after two minutes of both hypercapnic challenges. BOLD-MRI: Normoxic-hypercapnia caused immediate marked reduction in SI in placenta (-44% ± 5.5; p < 0.001), fetal liver (-32% ± 6.4; p < 0.001) and fetal heart (-53% ± 9.9; p < 0.001) but only minor changes in fetal brain (-13% ± 3.4; p < 0.01), suggesting fetal brain sparing. Doppler: Normoxic-hypercapnia caused a marked increase in umbilical artery PI (+27.4% ± 7.2; p < 0.001) and a reduction in fetal heart rate (-48 bpm; 95%CI -9.3 to -87.0; p = 0.02), suggesting acute fetal asphyxia. Brief maternal hypercapnic challenge caused BOLD-MRI changes consistent with acute placental and fetal hypoperfusion with fetal brain sparing. The same challenge caused increased umbilical artery PI and fetal bradycardia on Doppler ultrasound, suggestive for acute fetal asphyxia. BOLD-MRI may be a suitable noninvasive imaging strategy to assess placental and fetal organ hemodynamics.
BMC medical education, Jan 18, 2017
During their final year of medical school, Israeli students must consider which specialty to choo... more During their final year of medical school, Israeli students must consider which specialty to choose for residency. Based on the vocational counseling literature we presumed that choices are made by selecting from a cluster of related specialties while considering professional and socio-economic issues. Questionnaires distributed to final-year medical students at two Israeli medical schools ascertained inclinations toward various medical specialties and the importance of various selection criteria. Analysis focused on seven specialties where >20% of students reported they had positive inclinations. For each such specialty, the specialty and selection criteria query were compared using unpaired two-tailed Student's t-tests to determine differences between students with positive inclinations toward the specialty with those not so inclined. These data were placed in tables, with the significant differences highlighted to facilitate visual recognition of cluster patterns. Complete...