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Yogev Y.,Helen Schneider Hospital for Women | Sheiner E.,Soroka University Medical Center
Clinical Insights: Obesity & Pregnancy | Year: 2013

The growing 'obesity epidemic' in the Western world is of particular concern for women of childbearing age. Both short- and long-term effects are associated with obesity in pregnancy for both the mother and her offspring. The nine chapters of this book are organized according to the natural course of the association between obesity and pregnancy. The book commences with an examination of the association between obesity and general maternal health during pregnancy and in nonpregnancy. The book then addresses the complications of obesity in pregnancy, screening and treatment of diabetes, weight optimization and weight gain during pregnancy, bariatric surgery and the impact on pregnancy outcome, appropriate antenatal care, considerations for labor and delivery, postnatal care, and finally, the association between maternal obesity and long-term sequelae to the offspring. The book includes thought-provoking discussion between the Editor and other authors together with multiple choice questions - a feature in all Clinical Insights books - facilitating continued learning for established professionals and providing a useful learning tool for those seeking deeper insight into these topics. © 2013 Future Medicine Ltd. All rights reserved. Source

Blumer I.,Charles st Diabetes Center | Hadar E.,Helen Schneider Hospital for Women | Hadden D.R.,Royal Victoria Hospital | Jovanovic L.,Sansum Diabetes Research Institute | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Objective: Our objective was to formulate a clinical practice guideline for the management of the pregnant woman with diabetes. Participants: The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, 5 additional experts, a methodologist, and a medical writer. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: One group meeting, several conference calls, and innumerable e-mail communications enabled consensus for all recommendations save one with a majority decision being employed for this single exception. Conclusions: Using an evidence-based approach, this Diabetes and Pregnancy Clinical Practice Guideline addresses important clinical issues in the contemporary management of women with type 1 or type 2 diabetes preconceptionally, during pregnancy, and in the postpartum setting and in the diagnosis and management of women with gestational diabetes during and after pregnancy. Copyright © 2013 by The Endocrine Society. Source

Oron G.,Helen Schneider Hospital for Women | Ben-Haroush A.,Helen Schneider Hospital for Women | Goldfarb R.,Helen Schneider Hospital for Women | Molad Y.,Rheumatology Unit | And 2 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2011

Objectives. Anti-β2 glycoprotein 1 (a-β2GP1) was added to the criteria for antiphospholipid syndrome (APS) in 2005. However, its clinical significance with respect to complications of pregnancy is not well established. The aim of this study was to evaluate the association of laboratory findings of a-β2GP1 with events of thromboembolism or obstetric complications (pregnancy loss, placental dysfunction, intrauterine growth restriction, preeclampsia, fetal death, and preterm delivery) in women with clinical and laboratory evidence of APS. Methods. A retrospective cohort design was used. Ninety-one patients (total 394 pregnancies) referred to a tertiary medical center for evaluation of clinical features consistent with APS were divided into three groups: group A (n = 34), two positive tests for anticardiolipin (ACL) or lupus anticoagulant (LAC), in accordance with original APS classification (1998); group B (n = 18), two positive tests for a-β2GP1, in accordance with the revised APS criteria; and group C (n = 39), only one positive test for ACL or LAC. Results. Of the 52 women with APS (group A or B), 36 had primary disease, and 16 had secondary disease. On comparison of the groups, group B was characterized by a significantly higher rate of complicated pregnancy (83.3%) than groups A (47.1%) and C (76.9%), P = 0.007, and a higher rate of fetal loss (72.2%) than groups A + C (28.8%, P = 0.001). Conclusions. The findings suggest that the revised APS criteria are preferable to the original classification for the prediction of complicated pregnancy. © 2011 Informa UK, Ltd. Source

Ben-Aharon I.,Institute of Oncology | Ben-Aharon I.,Tel Aviv University | Granot T.,Institute of Oncology | Meizner I.,Helen Schneider Hospital for Women | And 13 more authors.
Oncologist | Year: 2015

Background. We previously reported that chemotherapy-induced ovarian toxicity may result from acute vascular insult, demon- strated by decreased ovarian blood flow and diminished post- treatment anti-Müllerian hormone (AMH) levels. In the present study, we report the continuous prospective evaluation of ovarian function in that cohort. Methods. Patients (aged,43 years) with localized breast cancer were evaluated by transvaginal ultrasound prior to initiation of chemotherapy, immediately at treatment completion, and at 6 and 12 months after treatment cessation. Doppler flow velocity indices of the ovarian vasculature (resistance index [RI], pulsatility index [PI]) were visualized. Hormone markers of ovarian reserve were assessed at the same time points. Results. Twenty patients were enrolled in the study. Median age was 34 6 5.24 years. Ovarian blood flow was significantly reduced immediately following chemotherapy (both RI and PI; p 5.01).These parameterswerepartially recovered at later points of assessment (6 and 12 months after treatment); patients aged,35 years significantly regained ovarian blood flow compared with patients aged.35 years (p,.05). AMH dropped dramatically in all patients following treatment (p,.001) and recovered in only 10 patients. Hormone markers of ovarian reserve shortly after chemotherapy depicted a postmenopausal profile for most patients, accompanied by related symptoms. Follicle-stimulating hormone (FSH) levels recovered in 14 of 20 patients and significantly returned to the premenopausal range in patients aged,35 years (p 5.04); 10 of 20 resumed menses at 12 months. The pattern of vascular impairment was lessened in patients treated with a trastuzumab-based protocol, although results did not reach statistical significance (p 5.068). Conclusion. Continuous prospective evaluation of ovarian vasculature and function in a cohort of young patients during and after chemotherapy indicated that ovarian toxicity may derive from acute vascular insult. Age may affect whether patients regain ovarian function, whereas recovery of blood flow and premenopausal FSH levels at later assessment was notable in patients aged,35 years. © Alpha Med Press 2015. Source

Ben-Haroush A.,Helen Schneider Hospital for Women | Ben-Haroush A.,Tel Aviv University | Poran E.,Helen Schneider Hospital for Women | Poran E.,Tel Aviv University | And 4 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2010

Objective. To determine if vaginal ultrasound for cervical length measurement induces the release of vaginal fetal fibronectin (fFN), leading to a false-positive fFN test. Methods. Participants included women with singleton pregnancies at 24-34 weeks' gestation who presented with uterine contractions without bleeding or membrane rupture. Women who had had intercourse or underwent pelvic examination less than 24h previously were excluded. The first fFN test was followed immediately by vaginal ultrasonography with a transvaginal probe (three images per patient) and, thereafter, a second fFN test. Results. The first fFN test was positive in three patients, and in all, the second, post-ultrasound, fFN test was also positive. In all women with a negative baseline fFN test (n=25), the second, post-ultrasound, fFN test was also negative. Conclusion. Vaginal ultrasound examination does not artificially change the fFN status. This is in contrast to common understanding and may permit the performance of ultrasound examination before fFN, which can be restricted to cases of short cervix. © 2010 Informa UK Ltd. Source

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