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.
Mazze R.,Collaborating Center |
Yogev Y.,Helen Schneider Hospital for Women |
Langer O.,St Lukes Roosevelt Hospital Center
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2012
In pregnancy complicated by diabetes periods of hyperglycemia lead to accelerated fetal growth, resulting in a large for gestational age (LGA), or macrosomic, infant. Consequently, our aim was to measure the average volatility or variability in glucose control in women with and without diabetes in pregnancy. Methods: Continuous glucose monitoring (CGM) was employed in 82 pregnant study subjects to collect and record unbiased self-monitored glucose values. We obtained results from 51 women with normal glucose tolerance in pregnancy (NGTP), 25 gestational diabetes (GDM) and 6 women with pregestational diabetes (PreGD) between 18 and 45 (32±6) years of age. Results: Significant differences (p<0.001) were found in glucose exposure between NGT and all but PreGD; whereas the percent of time in hypoglycemia was significantly (p<0.0001) higher in all pregnancy groups when compared to the nonpregnant sample. We conclude that CGM confirmed that diurnal glucose patterns differ throughout the day by 20% when pregnant and nonpregnant states are compared. Indeed, maintenance of a narrow range in pregnancy is characteristic in women without diabetes, and CGM throughout pregnancy is critical, if mimicking normal glucose patterns is to be achieved. © 2012 Informa UK, Ltd.
Krissi H.,Helen Schneider Hospital for Women
Gynecologic and Obstetric Investigation | Year: 2015
Aims: To investigate a trend for adnexal torsion direction and factors that may be associated with direction. Methods: We retrospectively reviewed the medical files of all women who underwent exploratory laparoscopy for suspected ovarian torsion in our center from August 2010 to December 2012. Results: Fifty-five women had laparoscopically proven torsion. Medial rotation, defined as clockwise rotation of the left adnexa or counterclockwise rotation of the right adnexa, with the proximal (lateral) segment of the infundibulopelvic ligament serving as the referral point was noted in most cases (n = 47, 85.5%). There was no statistically significant difference between the medial and lateral rotation groups. However, the proportion of pregnant women and mean parity were significantly higher in the lateral compared to the medial rotation group: 62.5 vs. 19.1%, p = 0.009 and 1.1 ± 1.2 vs. 0.1 ± 0.4, p < 0.001. Medial torsion was present in 64.3% of pregnant women vs. 92.7% of nonpregnant women, p = 0.009. Conclusion: The direction of ovarian or adnexal torsion is usually medially rotated, opposite to the psoas muscles and the great blood vessels on the same side. However, surgeons should be aware of an increased rate of lateral rotation among pregnant women. © 2015 S. Karger AG, Basel Copyright © 2015, S. Karger AG. All rights reserved.
Abir R.,Helen Schneider Hospital for Women |
Fisch B.,Helen Schneider Hospital for Women
Reproductive BioMedicine Online | Year: 2011
A report has been published which shows a connection between single nucleotide polymorphisms (SNP) in the bone morphogenetic protein 15 (BMP15) gene and ovarian hyperstimulation syndrome (OHSS) in women, similar to reported effects of heterozygous BMP15 point mutations in sheep. The report also describes the near-significant presence of another BMP15 gene SNP correlated with a low response to ovarian stimulation. Previous studies associated two SNP with anovulation or infertility in women with polycystic ovary syndrome, and heterozygosity for another BMP15 SNP resulted in ovarian dysgenesis and hypergonadotrophic failure. In sheep, homozygous point mutations or immunization against BMP15 led to follicular developmental arrest, ovarian dysgenesis and streak ovaries. In mammalian (including human) ovaries BMP15 and its three receptors were shown to be expressed from primary or primordial follicular stages, suggesting that BMP15 might also be involved in activating primordial follicles, and could possibly serve as a marker of follicular reserve. BMP15 also inhibited follicle stimulating hormone receptor expression, was associated with cumulus expansion and its high follicular-fluid concentration was correlated with improved oocyte and embryo quality. Thus, BMP15 seems to be an important regulator of ovarian function. Further studies are needed to clarify its roles in human female fertility. © 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
Ashwal E.,Helen Schneider Hospital for Women |
Hod M.,Helen Schneider Hospital for Women
Clinica Chimica Acta | Year: 2015
Gestational diabetes mellitus (GDM) is defined as any carbohydrate intolerance first diagnosed during pregnancy. The prevalence of GDM is about 2-5% of normal pregnancies and depends of the prevalence of same population to type 2 diabetes mellitus. It is associated with adverse outcome for the mother, the fetus, neonate, child and adult offspring of the diabetic mother. Detection of GDM lies on screening, followed as necessary by diagnostic measures. Screening can either be selective, based upon risk stratification or universal. Timely testing enables the obstetrician to assess glucose tolerance in the presence of the insulin-resistant state of pregnancy and permits treatment to begin before excessive fetal growth has occurred. Once a diagnosis of GDM was made close perinatal surveillance is warranted. The goal of treatment is reducing fetal-maternal morbidity and mortality related with GDM. The exact glucose values needed are still not absolutely proved. The decision whether and when to induce delivery depends on gestational age, estimated fetal weight, maternal glycemic control and bishop score. Future research is needed regarding prevention of GDM, treatment goals and effectiveness of interventions, guidelines for pregnancy care and prevention of long term metabolic sequel for both the infant and the mother. © 2015 Elsevier B.V.
Melamed N.,Helen Schneider Hospital for Women |
Hiersch L.,Helen Schneider Hospital for Women |
Domniz N.,Helen Schneider Hospital for Women |
Maresky A.,Helen Schneider Hospital for Women |
And 2 more authors.
Obstetrics and Gynecology | Year: 2013
OBJECTIVE:: To assess the predictive role of ultrasonographic cervical length for preterm delivery in women with threatened preterm labor. METHODS:: A retrospective cohort study of women with singleton pregnancies who presented with preterm labor before 34 weeks of gestation and underwent ultrasonographic measurement of cervical length in a tertiary medical center. Women with cervical cerclage, cervical dilatation greater than 3 cm at presentation, and pregnancies complicated by placental abruption, clinical chorioamnionitis, stillbirth, or major fetal anomalies were excluded. The predictive accuracy of cervical length for preterm delivery was analyzed using both fixed thresholds and outcome-specific thresholds, which are associated with a detection rate of 90%, false-positive rate of 10%, or the inflexion point of the receiver operator characteristic curve. RESULTS:: Between 2007 and 2012, 1,077 women presented with preterm labor and met the study criteria. The correlation between cervical length and the time interval to delivery was significant but weak (r=0.293, P<.001). Cervical length was independently associated with the risk of preterm delivery at less than 37, 35, and 32 weeks of gestation and within 14 and 7 days from presentation (a 4-7% decrease in the risk for each additional millimeter of cervical length) as well as with the time interval between presentation and delivery (each additional 2 mm was associated with an increase of 1 day). Overall, the accuracy of cervical length in predicting preterm delivery was relatively poor. CONCLUSION:: Although cervical length is an independent predictor of preterm delivery in women with preterm labor, its predictive accuracy as a single measure is relatively limited. © 2013 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.
Sheiner E.,Health Science University |
Willis K.,Ben - Gurion University of the Negev |
Yogev Y.,Helen Schneider Hospital for Women |
Yogev Y.,Tel Aviv University
Current Diabetes Reports | Year: 2013
The dramatic increase in the prevalence of obesity in women of reproductive age has resulted in approximately 1 in 5 women being obese when they conceive. Bariatric surgery has been shown to be the most effective long-term weight loss strategy in obese women in this age group. Clinicians should be aware of the effects of bariatric surgery on fertility and future pregnancies. Regarding certain complications, pregnancy after bariatric surgery appears to be safer than pregnancy in the obese. In patients where nutrition is properly maintained and monitored, the risks for obesity-related obstetric complications, such as gestational diabetes mellitus and hypertension, are significantly reduced, but possibly at the expense of an increase in neonates born small-for-gestational- age. At the present, definitive conclusions cannot be drawn concerning the risk for Caesarian delivery, differences in type of bariatric procedure, or the optimal surgery-to-conception interval. © 2012 Springer Science+Business Media New York.
Aviram A.,Helen Schneider Hospital for Women |
Hod M.,Helen Schneider Hospital for Women |
Yogev Y.,Helen Schneider Hospital for Women
International Journal of Gynecology and Obstetrics | Year: 2011
As obesity becomes a worldwide epidemic, its prevalence during reproductive age is also increased. Alarming reports state that two-thirds of adults in the USA are overweight or obese, with half of them in the latter category, and the rate of obese pregnant women is estimated at 18-38%. These women are of major concern to women's health providers because they encounter numerous pregnancy-related complications. Obesity-related reproductive health complications range from infertility to a wide spectrum of diseases such as hypertensive disorders, coagulopathies, gestational diabetes mellitus, respiratory complications, and fetal complications such as large-for- gestational-age infants, congenital malformations, stillbirth, and shoulder dystocia. Recent reports suggest that obesity during pregnancy can be a risk factor for developing obesity, diabetes, and cardiovascular diseases in the newborn later in life. This review will address the implication of obesity on pregnancy and child health, and explore recent literature on obesity during pregnancy. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Melamed N.,Helen Schneider Hospital for Women |
Yogev Y.,Helen Schneider Hospital for Women |
Yogev Y.,Tel Aviv University |
Glezerman M.,Helen Schneider Hospital for Women
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2010
Objective.To assess the effect of fetal gender on pregnancy outcome. Methods.Retrospective study of all singleton pregnancies at a tertiary hospital during 19952006. Results.Of the 66,387 women studied, 34,367 (51.8) delivered male and 32,020 (48.2) delivered female neonates. The rate of preterm delivery (as early as 29 weeks) was higher for male fetuses and was attributed to an increased incidence of spontaneous preterm labor and preterm premature rupture of membranes. Women carrying male fetuses were at increased risk for operative vaginal delivery (OVD) for non-reassuring fetal heart rate, failed OVD and cesarean delivery. Female fetuses were more likely to experience fetal growth restriction (FGR). Conclusion. Fetal gender is independently associated with adverse pregnancy outcome. Although the added risk is relatively small, further investigation of the mechanisms underlying this association may contribute to our understanding of the pathophysiology of pregnancy complications such as preterm delivery and FGR. © 2010 Informa UK Ltd.
Cohen Sacher B.,Helen Schneider Hospital for Women
Clinical Obstetrics and Gynecology | Year: 2015
The appearance of the female external genitalia is key for understanding and diagnosing many diseases that women of all ages encounter. Alas, the normal appearance of the vulva is an elusive concept, scarcely represented in textbooks, and the growing number of vulvar cosmetic surgery calls for a review of the normal appearance of the vulva and its diversity. In this paper I will review vulvar embryology, anatomy, the current literature discussing vulvar appearance, and describe meticulous vulvar examination, including the diagnostic tools. © Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.