Tamar Tzur

Illegal drug abuse causes significant health problems with consequences to the mother and the neonate, and an economic burden to the health system. The present study aimed to investigate pregnancy and perinatal outcome in women using illegal drugs prior to and during pregnancy. A retrospective cohort study comparing pregnancy and neonatal outcomes of drug addicted women to the outcomes of other Jewish women. The study population includes all women who gave birth between the years 1989-2008 at the Soroka University Medical Center. From a total of 106,000 deliveries, 119 women were known to be drug addicted. No significant differences were found between the groups regarding maternal age and origin, but more women in the addicted group smoked, and tacked prenatal care. More women in the addicted group had obstetrics complications such as: recurrent abortions, placenta previa, pLacental abruption and preterm labor. Illegal drug abuse was significantly associated with adverse perinatal o...

Neonatal hemochromatosis (NH) is a rare disease which has been characterized as severe neonatal liver disease in association with extrahepatic siderosis in a distribution similar to that seen in HFE-associated hereditary hemochromatosis. The clinical presentation is severe liver dysfunction that could lead to intrauterine fetal death or the neonate death. The treatment is antioxidants, chelation or cocktail liver transplant. The prognosis is very bad with less than 40% survival. The etiology and pathogenesis are yet unknown. It has been considered to be a syndrome in which a number of primary etiologies, such as infection, genetic-metabolic disease and toxic insult, lead to a common phenotype. The common hypothesis now is that NH is a consequence of gestational alloimmune disease. The basis for this theory rests on the pattern of recurrence. Little direct evidence for an immune mechanism exists. The fact that high-dose intravenous immunoglobulin appears to lessen the severity, impro...

Timing of elective repeat caesarean section should take into account both fetal and maternal considerations. The percentage of caesarean deliveries has dramatically increased during the last decades. It undoubtedly leads to an increase in the number of women having multiple caesarean sections. While maternal morbidity increases with increased number of caesarean sections, when compared with their term counterparts, late pre-term infants face increased morbidity. Establishing the optimal time of delivery for both mother and child is a major challenge faced by clinicians. The aim of this review is to better understand neonatal and maternal morbidity and mortality that are associated with elective repeat caesarean section, and to provide an educated decision regarding the optimal timing for elective repeat caesarean section.

To examine whether an association exists between platelet (PLT) count in the first trimester of pregnancy and the risk for hypertensive disorders or other obstetric complications. The study population included all registered births with available PLT count from the first trimester of pregnancy during 2000-2010. Thrombocytopenia was defined as PLT count below 100,000/μL. A comparison was performed between women with and without thrombocytopenia. Multiple logistic regression models were used to control for confounders. The study population included 33,890 deliveries; of these, 119 (0.35%) were with thrombocytopenia. Women with thrombocytopenia had significantly higher rates of preterm delivery (16.0% vs. 9.4%; p = 0.015). There was no significant difference between the groups regarding hypertensive disorders. Hypertensive disorders cannot be predicted based on PLT count during the first trimester of pregnancy. Nevertheless, thrombocytopenia during the first trimester is a risk factor for preterm delivery.

To examine the association between calcium levels during the first trimester of pregnancy and preeclampsia. The study population included registered births (n = 5233) in a tertiary medical center between 2001 and 2011. A comparison was performed between women with and without hypocalcemia during the first trimester of pregnancy. A second analysis was performed after correcting calcium levels for albumin. Multiple logistic regression models were used to control for confounders. Receiver operating characteristic curve analysis graphs were used to describe the relationship between the true-positive rate (sensitivity) and the false-positive rate for different values of calcium during the first half of pregnancy in the prediction of preeclampsia. Of 5233 deliveries, 841 (16%) had hypocalcemia and 4392 (84%) had a normal calcium level. No significant difference were found between the groups regarding mild preeclampsia [odds ratio (OR) = 1.216; 95% confidence interval (CI) 0.831-1.779; p = 0.312], severe preeclampsia (OR = 1.618; 95% CI 0.919-2.849; p = 0.092) and any hypertensive disorders (OR = 1.324; 95% CI 0.963-1.821; p = 0.083). Hypocalcemia during the first trimester of pregnancy is not a risk factor for preeclampsia.

To examine whether an association exists between maternal leukocyte count in the first trimester of pregnancy and the risk for development of obstetric complications. The study population included all the registered births (n = 33,866) with available white blood cell count (WBC) from the first trimester of pregnancy, during 2000-2010 in a tertiary medical center. The leukocyte count was sorted by the following groups: WBC < 3.5 10 × 9/l, WBC = 3.5 10 × 9/l-13.8 10 × 9/l, and WBC > 13.8 10 × 9/l. These groups were compared regarding obstetrical characteristics and perinatal outcomes. Multiple logistic regression models were used to control for confounders. The study population included 33,866 deliveries, of these 0.94 % had leukocytosis WBC > 13.8 10 × 9/l. Women with leukocytosis delivered significantly earlier, were more likely to be Jewish, and in their first pregnancy. There were significantly higher rates of preterm delivery before 37 weeks, fertility treatments, hypertensive disorders, gestational diabetes mellitus, and cesarean section among these patients. There was no significant difference between the groups regarding preterm premature rupture of membranes (PPROM) and chorioamnionitis. Women with leukocytosis during the first trimester had significantly higher rates of fetuses who were small for gestational age and with birth weight <2,500 g. Multivariable analysis showed a significant association between preterm delivery before 37 weeks and leukocytosis during the first trimester of pregnancy (p = 0.003). Leukocytosis during the first trimester is significantly associated with an increased risk for obstetrical complications, in particular preterm delivery. Nevertheless, further studies should focus on women with leukocytosis during the first trimester in order to verify our results.