Harefuah最新文献

Introduction: A molar pregnancy with a complete fetus without abnormalities is extremely rare and carries significant risks for both the mother and the fetus. Mesenchymal dysplasia of the placenta is a tumor that is histologically different from a complete mole, but the sonographic appearance in these cases is very similar to a complete mole. The clinical behavior of both conditions is also very similar and poses significant risks to both the mother and the fetus. Therefore, early diagnosis and careful management of these cases are crucial to ensure the health of both the woman and the fetus in the event that the pregnancy is not terminated. We present a description of two cases: the first is a complete mole with a healthy fetus, and the second is mesenchymal dysplasia of the placenta, also with a healthy fetus.

Introduction: The optimal method for cervical ripening during labor remains debated.

Aims: To determine the effective cervical ripening method based on fetal indications.

Methods: A retrospective cohort study was conducted at a single tertiary center (2010-2021). Enrolled nulliparous women had a Bishop score of ≤6 and vertex presentation undergoing labor induction for fetal well-being indications (including non-reassuring fetal heart rate). Participants were categorized based on the ripening method used: prostaglandin E2 (PGE2) or cervical ripening balloon (CRB).

Results: The study included 716 nulliparous women: 462 (64.53%) induced by PGE2 and 254 (35.47%) induced by CRB. The duration from induction to delivery was similar for both PGE2 and CRB inductions (25 [15-41] vs. 26 [20-39] hours, p=0.34). There were no differences in delivery mode. Rates of chorioamnionitis and obstetric anal sphincter injury (OASIS) were lower with PGE2 (3.5% vs. 7.1%, p=0.021; 2.2% vs. 5.1%, p=0.034, respectively). No other significant differences were observed, including neonatal outcomes.

Conclusions: Neither method demonstrated overall superiority in terms of efficacy or neonatal outcomes, although PGE2 exhibited a lower maternal risk profile. This point should be taken into consideration.

Discussion: The study found similar efficacy between PGE2 and CRB for labor induction due to fetal indications in nulliparous women, with no difference in time to delivery or cesarean delivery (CDs). PGE2 demonstrated lower rates of chorioamnionitis and OASIS, suggesting better maternal safety. In cases of nulliparous women with an unripe cervix and fetal indications for induction, PGE2 and CRB are similarly effective. Nevertheless, PGE2 is associated with a lower risk of maternal complications.

Introduction: Premature rupture of membranes (PROM) refers to the spontaneous rupture of membranes before the onset of labor. PROM, regardless of gestational age, is linked to increased risks of perinatal infections and umbilical cord compression. Amniotic fluid plays a crucial role in fetal development and growth, and its volume is essential for proper fetal well-being. Measurement of amniotic fluid volume (AFV) through prenatal ultrasound has become a standard practice in fetal monitoring. While numerous studies have explored the relationship between AFV and preterm PROM, few have focused on its association with term PROM. The aim of our study was to evaluate the relationship and predictive value of ultrasound-measured AFV in relation to adverse pregnancy outcomes.

Methods: This retrospective study included women with singleton pregnancies with PROM admitted to Meir Medical Center, a tertiary academic medical center. Term PROM was defined as occurring between 37+0 and 41+6 weeks of gestation. The study received approval from the Research Ethics Committee of Meir Medical Center (MMC-0125-24). The women were divided into two groups based on their amniotic fluid index: normal AFV (≥5 cm) and oligohydramnios (<5 cm).

Results: A total of 537 women were admitted with PROM during the study period, and 402 met the inclusion criteria. Among them, 319 (79.4%) had normal AFV, and 83 (20.6%) had oligohydramnios. No significant differences were found between the two groups regarding maternal outcomes (postpartum hemorrhage, amnionitis, meconium-stained fluid, or placental abruption() or neonatal outcomes (respiratory distress, fetal sepsis, or neonatal intensive care unit (NICU) admission).

Conclusions: Women presenting with PROM and oligohydramnios can be reassured, as no association was found between AFV at the time of presentation and adverse pregnancy outcomes. Further research is needed to deepen our understanding of the relationship between amniotic fluid volume and membrane rupture at term.

Introduction: Optical coherent tomography (OCT) is an emerging non-invasive imaging technology with significant potential in fields of medicine where invasive biopsy is limited or impractical. In ophthalmology, where retinal biopsy is not possible, OCT has become a standard of care for monitoring physiologic and pathologic changes. Similarly, OCT holds promise for improving women's healthcare, particularly in areas where biopsies are not routinely performed due to anatomical, ethical, or patient comfort considerations. Genitourinary syndrome of menopause (GSM) is one such condition where OCT may provide significant clinical value. However, ethical and practical limitations often restrict the ability to perform repeated or even sporadic vaginal wall biopsies. As a result, the efficacy of new treatment modalities largely assessed through subjective patient-reported outcomes, leading to inconsistent and controversial data that hinder progress in the field. This review outlines a collaborative effort by scientists and clinicians at the University of California, Irvine, to develop a novel, non-invasive "optical biopsy" tool for external genital assessment. A dedicated system integrated within a vaginal probe was developed to combine energy-based treatment with real-time OCT imaging. The new system successfully detected differences in vaginal epithelial thickness (VET) and blood vessel density (BVD) across women of different age groups, and between different segments of the vaginal wall. The system was used to measure VET and BVD changes before and after treatment with Fractional-Pixel CO2 laser. Beyond GSM, this technology is now being applied to other vulvovaginal conditions, including vulvar lichen sclerosus (VLS). The ability to perform non-invasive real-time monitoring of tissue structure and function is a critical step forward in women's health, offering new opportunities for diagnosis, treatment, monitoring, and ultimately improving clinical outcomes.

Objectives: Twin gestations are subjected to higher rates of growth abnormalities. Accurate, locally customized reference values may contribute to an accurate diagnosis of abnormal growth. We aimed to determine reference values for sonographically estimated fetal weight (sEFW) and biometry in twin gestations.

Methods: A multicenter retrospective longitudinal analysis of sEFW and biometric measurements evaluations of twin gestations was performed between 2010 and 2022 in 11 medical centers in Israel. The sEFW at 14-40 gestational weeks was calculated using the Hadlock 1985 formula. Only data from viable twins delivered at or above 34 gestational weeks were included. Cases that underwent early fetal reduction or cases that were diagnosed with major congenital fetal anomalies or genetic aberrations were excluded. The non-parametric Quantile Generalized Additive Model (QGAM) approach was employed for building the growth curves.

Results: A total of 7,060 fetuses and 18,248 measurements were incorporated in the sEFW and biometry growth curves. The cohort included 3,449 (49%) dichorionic twins contributing 7,192 (40%) of measurements. The rest were monochorionic twins (536, 8% of twins; 1,866, 10% of measurements) or with unknown chorionicity (3,066, 43% of twins; 9,171, 50% of measurements). The cohort included 49% females and 51% males when gender was reported (N=10,945 evaluations). Similar growth curves were observed when curves were split according to chorionicity, when the cohort included only twins delivered after 36 gestational weeks, and following the exclusion of discordant twins above 30%.

Conclusions: Reference values for twins' sEFW and biometric measurements are presented for the Israeli population for clinical and research use. Since sEFW and biometry reference values determine fetal growth assessment and subsequent pregnancy management, this study has significant implications for Israeli health policy related to twin pregnancy care.

Introduction: Adnexal torsion is responsible for 2.7% of gynecological emergencies. Ultrasound is the test of choice for this diagnosis, but there is some evidence of non-significant difference between ultrasound and computed tomography, in terms of sensitivity and specificity. We present a case of ovarian torsion, in which the ultrasound examination was technically suboptimal, and computed tomography imaging had an important diagnostic role, demonstrating a "Whirlpool sign". This case emphasizes the importance of the use of different and complementary imaging modalities, and the importance of reinterpretation of imaging in clinical practice.

Introduction: The legal and regulatory status of child welfare considerations in fertility treatments in Israel remains unclear and inconsistent. As a result, fertility specialists are often required to make judicial-like decisions regarding prospective parental fitness, frequently without appropriate guidelines, training, or systemic support. This article explores the practical dilemmas that arise from this regulatory void in Israel and highlights the shortcomings of the current system. It reviews relevant legal and clinical approaches from various countries, illustrating different models for addressing the physician's responsibility in considering the welfare of the future child. The authors conclude with a call for regulatory reform to establish a structured division of responsibility between physicians and multidisciplinary professional teams, ensuring more consistent, informed, and ethically sound decision-making.

Introduction: The surgical procedure of the operative opening of the uterus and delivering the fetus known as cesarean section was probably practiced for thousands of years. Delivery of a living child after the death of its mother (the postmortem procedure) is referred to in the myths and folklore of many ancient societies. Some of the newborns so delivered survived, although their mothers did not. The current review describes ten anecdotes from about 3800 years of written history of cesarean section. These stories illustrate the evolution of cesarean section from postmortem to the lifesaving procedure of the parturient and her infant.

Introduction: Despite all the knowledge reached regarding preeclampsia, including preventive strategies, predictive algorithms, diagnosis and treatment, we still encounter cases that rapidly deteriorate while jeopardizing the patient and her fetus. It is known that hypertension constitutes a considerable portion of pregnancy complications and is associated with significant maternal and perinatal morbidity and mortality. A continuous global increase in its prevalence is noted, mainly due to lifestyle changes, a tendency toward obesity, and delayed childbearing to a more advanced age. We present a case of rapid deterioration of a 35-year-old parturient who underwent an emergency cesarean section at 33 weeks of gestation due to superimposed preeclampsia with severe features. The patient developed chronic hypertension-related target organ damage such as hypertensive cardiomyopathy and retinopathy, and developed acute complications, including uncontrolled blood pressure, pulmonary edema, Type-2 myocardial infarction and renal insufficiency. Following surgery, she was admitted to the intensive care department, and as her condition stabilized, follow-up treatment took place at the maternity ward. Treatment was provided by a multidisciplinary team including: the obstetrics division, with the intensive care department, the cardiology division, and the nephrology institute. The patient was eventually discharged for continued outpatient follow-up. The nephrology follow-up raised relevant differential diagnosis in accordance with the patient's personal and family history, and in collaboration with the genetics unit, a monogenic hypertensive disorder was suspected and sought. This case underscores the importance of early diagnosis of high-risk cases in general, and chronic hypertension in particular, and thorough evaluation and recommendations for preventive medicine. It highlights the necessity of appropriate treatment adaptation, patient adherence and compliance, and maintaining blood pressure control, as well as early identification and management of acute and chronic disease-related complications. If a genetic basis for the condition is confirmed, we can identify and counsel other family members and encourage early monitoring and treatment before target organ damage occurs.

Introduction: In recent decades, a gender revolution has transformed the medical profession, with women becoming the majority in the workforce and increasingly dominating obstetrics and gynecology (Ob&Gyn), particularly in residency selection.

Aims: No prior research has explored the determinants behind women's preference for this residency in Israel or its anticipated impact.

Methods: Qualitative research was conducted using unstructured, in-depth, interviews with 64 medical students randomly selected from Ben-Gurion University and the Technion, alongside 24 senior doctors and residents from the gynecology divisions at Soroka University Medical Center and Rambam Health Care Campus. The data subsequently underwent comprehensive thematic, focused, and interpretive analysis.

Results: Among female medical students, obstetrics and gynecology is highly favored (41.4%). The primary motivation was professional interest (97%). Yet, many express concerns regarding work conditions that impact both personal and family life (42% and 37%, respectively). The clerkship exerts a crucial influence on residency decisions, as cited by 86% of students. Conversely, senior physicians worry that the increasing feminization will diminish its prestige and lower salaries. However, among students, such concerns are secondary; 62% believe that the shift towards predominantly female physicians will substantially shape the future trajectory of the field.

Conclusions: Within a decade, obstetrics and gynecology will evolve into a field predominantly led by female physicians. This gender shift will transform work routines and reshape healthcare systems with significant impact in Israel and across the western world confronting comparable trends.