ABSTRACT:Cervical intraepithelial neoplasia (CIN) 2-3, a premalignant lesion usually treated by Loop Electrosurgical Excision Procedure (LEEP) in nonpregnant women, is addressed differently in pregnant women. Data from 2006 to 2023 on 178 pregnant women with CIN 2-3 were provided by the Israeli Society of Colposcopy. Sixty-seven underwent LEEP within 15 weeks of gestation with only minor complications. Of the 57 continuing pregnancies, 53 (93%) delivered at term, 2 (3.5%) at 34-37 weeks, and 2 (3.5%) experienced missed abortions. One hundred eleven women were followed through pregnancy without LEEP. Of that group, 5 women were lost to follow-up. From 173 women on whom the authors have follow-up data, 9 (5.2%) were finally diagnosed with cervical cancer, 132 women (76.3%) remained CIN 2-3, and 32 women (18.5%) were CIN 1 or normal. Loop Electrosurgical Excision Procedure (LEEP) performed within the first 15 weeks of pregnancy in 67 women was safe. In 5.2% of pregnant women with CIN 2-3, the final diagnosis was invasive cancer.

Optimal sperm DNA integrity is essential for fertilization and embryo health. Research indicates that testicular sperm (TS), obtained via TESA or TESE, typically show lower sperm DNA fragmentation (SDF) than ejaculated sperm after standard abstinence. Shortening abstinence to less than 2 days might reduce SDF, offering a less invasive and more cost-effective alternative to surgical sperm retrieval. Yet, no studies have directly compared the efficacy of shorter abstinence against TS extraction for lowering SDF. Our meta-analysis aims to address this gap by comparing SDF levels in TS to those in ejaculated sperm after a short abstinence period. Meta-analysis of 16 randomized controlled and prospective observational studies included 4 on TS and 12 on short abstinence ejaculation. The meta-analysis followed MOOSE guidelines, scrutinizing databases including Cochrane Library, Web of Science, Embase, MEDLINE(R), and PUMBED up to November 16, 2023. The analysis was conducted using RevMan. The observational studies’ methodological quality was assessed using the Newcastle–Ottawa Scale, and the overall evidence quality was evaluated following the GRADE criteria. To compare short ejaculation duration and TS (are not directly compared in the literature) for SDF levels, we analyzed relevant data from studies of each method. We adjusted the participant numbers in the TS group by 1/3 and included each TS study three times, to perform a comparison against the short duration studies which were in a ratio of 1:3. This approach maintained an unaltered cumulative subject count for the meta-analysis of TS studies. A total of 641 patients were included, comprising 120 and 521 patients with SDF measurements following TS and ejaculation after a short abstinence period, respectively. The studies had varied inclusion criteria, with not all patients having an initial elevated SDF. Some studies had incomplete details on age and other demographics. However, the mean ± SD age of 93 TS patients was 38.15 ± 5.48 years vs. 37.7 ± 6.0 years of 444 short abstinence patients, demonstrating no significant difference (P = 0.544). Short abstinence durations ranged from 1 to 48 h. Diverse DNA fragmentation tests were used: TUNEL assay in three testicular sperm studies, SCD assay in one, and in the short abstinence group, four used TUNEL and six used SCD assays, along with one each using SCSA and Halosperm. The mean ± SD SDF was lower in the TS group than in the short abstinence group (mean difference − 9.48, 95

Objective: To identify risk factors for readmission following methotrexate treatment for tubal pregnancy. Methods: A retrospective study undertaken in two tertiary medical centers, including all individuals with medically treated tubal pregnancy (N = 511), between December 2009 and June 2021. Individuals with and without readmission following methotrexate treatment were compared. The primary outcome was the readmission rate. Secondary outcomes included the rate of post-discharge gynecological emergency department visits, tubal rupture rate, and the eventual need for surgical treatment. Results: Readmission following methotrexate treatment occurred in 224/511 patients (43.8%). Most readmissions were due to abdominal pain or suspicion of treatment failure. Readmitted individuals were more likely to have a history of pelvic inflammatory disease and pretreatment serum human chorionic gonadotropin (hCG) >2000 mIU/mL. Both factors remained significantly associated with higher readmission rates in a logistic regression analysis (adjusted odds ratio [OR] 6.28, 95% confidence interval [CI] 1.30-30.45, and adjusted OR 2.73, 95% CI 1.83-4.07, respectively) after adjustment for age, endometriosis, tubal pathology, abdominal pain, and presence of yolk sac or embryo at diagnosis. A dose-dependent association was observed between pretreatment serum hCG levels and readmission rate (P < 0.001). Pretreatment hCG levels were also associated with tubal rupture and the eventual need for surgical treatment (P < 0.001 for both). A prediction model using hCG was not sufficiently accurate to predict readmission risk. Conclusion: Readmission following methotrexate treatment for tubal pregnancy was independently associated with previous pelvic inflammatory disease and pretreatment serum hCG levels. The latter was also associated with surgical intervention rate.

Objective: To describe outcomes of expectant management (EM) versus methotrexate (MTX) treatment in tubal pregnancies with pretreatment human chorionic gonadotropin (hCG) less than 2000 mIU/mL. Methods: This retrospective cohort from two tertiary hospitals included women with confirmed tubal pregnancies and pretreatment hCG < 2000 mIU/mL. Exclusion criteria were unrecorded pregnancy site, unconfirmed diagnosis, and surgical treatment upon diagnosis. The primary outcome was eventual rate of surgical treatment. Results: Between December 2009 and June 2021, 545 of 2114 (25.8%) women diagnosed with a tubal pregnancy met our inclusion criteria. We compared women who underwent EM (N = 201) with women who received MTX (N = 344). All women in the EM group had a declining trend of hCG. The MTX group had higher pretreatment hCG and higher rates of yolk sac or embryo presence on ultrasound. Eventual surgical treatment rate was higher in the MTX group compared with the EM group (39 [11.3%] vs. 9 [4.5%], P = 0.006), with no difference in the treatment failure rate or tubal rupture rate. In a subgroup analysis of women with pretreatment hCG between 1000 and 2000 mIU/mL, eventual surgical treatment, treatment failure, and tubal rupture rates did not differ between groups. Logistic regression analysis revealed that eventual surgical treatment was independently associated with hCG levels less than 1000 mIU/mL (adjusted odds ratio [aOR] 0.28, 95% confidence interval [CI] 0.14-0.56) and endometriosis (aOR 9.20, 95% CI 3.55-23.81). Conclusion: Expectant management of tubal pregnancies with pretreatment hCG levels less than 2000 mIU/mL and even between 1000 and 2000 mIU/mL and with a declining trend of hCG demonstrated lower or comparable rates of eventual surgical treatment, when compared with MTX treatment.

Objective: To compare in -vitro fertilization (IVF) outcomes in polycystic ovary syndrome (PCOS) patients treated with follicle stimulating hormone (FSH) alone or FSH and luteinizing hormone (LH), under freeze -all gonadotropin-releasing hormone (GnRH) antagonist protocols. Material and Methods: This retrospective study at a university center included PCOS patients, who underwent freeze -all GnRH antagonist IVF cycles between January 2013 and December 2019. They were divided into FSH-only and FSH + LH groups, focusing on pregnancy and live birth rates. Results: The study included 82 patients: 43 received FSH + LH and 39 FSH only. Baseline characteristics were similar, except for higher thyroid stimulating hormone levels in the FSH-only group. The FSH + LH group required a lower mean +/- standard deviation total dose of FSH (1271.5 +/- 376.7 vs. 1407.2 +/- 645.3 IU, p=0.02), had a shorter mean cycle length (7.3 +/- 3.4 vs. 8.3 +/- 1.6 days, p=0.004), and had a higher mean number of follicles stimulated (36.9 +/- 15.9 vs. 35.9 +/- 9.7, p=0.008) compared to the FSH-only group. No significant differences in pregnancy and live birth rates were noted at first transfer, but the cumulative live birth rate was significantly higher in the FSH-only group [30 of 39 (76.9%) vs. 24 of 43 (55.8%), p=0.044]. Conclusion: LH supplementation in PCOS patients undergoing GnRH antagonist IVF protocols may impair cumulative live birth rates, despite lowering FSH requirement and reducing IVF cycle length. These results highlight the complex role of LH in IVF outcomes for PCOS patients, suggesting a need for further large studies to fully understand the impact of LH in such treatments. (J Turk Ger Gynecol Assoc 2024; 25: 60-5)

BACKGROUND:Studies aimed to assess risk factors for pelvic organ prolapse (POP) recurrence following colpocleisis with nonconclusive results. OBJECTIVE:To investigate risk factors for POP recurrence following colpocleisis. SEARCH STRATEGY:MEDLINE, PUBMED, Embase, Web of Science, and Cochrane databases were systematically searched. SELECTION CRITERIA:Experimental and non-experimental studies investigating POP recurrence following colpocleisis. DATA COLLECTION AND ANALYSIS:We assessed the association between preoperative and postoperative physical examination findings, demographics and medical history, and the risk of recurrence following colpocleisis. MAIN RESULTS:A total of 954 studies were identified, of which five studies comprising 2978 patients were eligible for analysis. Both preoperative and postoperative genital hiatus length were significantly longer in the recurrence group (mean difference [MD] 0.48, 95% confidence interval [CI] 0.01-0.94, P = 0.04, I2  = 0% and MD 1.15, 95% CI 0.50-1.81, P = 0.005, I2  = 0%; respectively). Preoperative total vaginal length (TVL) did not differ between groups (MD 0.05, 95% CI -0.40 to 0.50, P = 0.83, I2  = 6%), postoperative TVL was found significantly longer in the recurrence group (MD 0.07, 95% CI -0.03 to 1.38, P = 0.04, I2  = 68%). Both preoperative and postoperative perineal body did not differ between groups. Women with a previous POP surgery were more likely to experience recurrence following colpocleisis (relative risk 2.09, 95% CI 1.18-3.69, P = 0.01, I2  = 0%). Patient's age and previous hysterectomy did not affect recurrence rates. CONCLUSION:Wider preoperative and postoperative genital hiatus as well as longer post-operative TVL and previous POP surgery were associated with a higher risk for recurrence following colpocleisis, highlighting the importance of appropriate patient selection and surgical technique in minimizing this risk.

OBJECTIVE: This study aimed to assess the risk of stress urinary incontinence recurrence and reoperation after a midurethral sling procedure in women with subsequent childbirth and to assess the effect of delivery mode on this risk. DATA SOURCES: An electronic database search was performed using MEDLINE with the OvidSP interface and PubMed, Embase, Web of Science, and the Cochrane Library up to September 20, 2023. STUDY ELIGIBILITY CRITERIA: This study included experimental and nonexperimental studies, composed of randomized controlled and observational (case -control, cohort, and cross-sectional) studies assessing the risk factors for stress urinary incontinence recurrence and reoperation after childbirth in women who had previously undergone a midurethral sling procedure for stress urinary incontinence. METHODS: Analysis was performed using RevMan (version 5.3; Cochrane Collaboration, Oxford, United Kingdom). Quantitative synthesis was used if the included studies were sufficient in numbers and homogeneity. The overall certainty of the evidence was assessed using criteria recommended by the Grading of Recommendations Assessment, Development, and Evaluation Working Group. RESULTS: A total of 2001 studies were identified, of which 6 were eligible for analysis, composed of 381 patients who had at least 1 childbirth after a midurethral sling procedure (study group) and 860 patients who underwent a midurethral sling without having a subsequent childbirth (control group). All included studies were observational, the patients' mean age at the time of the midurethral sling procedure ranged from 34 to 36 years, and the mean time from midurethral sling procedure to delivery ranged from 21 to 31 months. No difference in stress urinary incontinence recurrence (relative risk, 0.1.02; 95% confidence interval, 0.78-1.33) or reoperation (relative risk, 1.37; 95% confidence interval, 0.87-2.17) was found between the study and control groups. The average follow-up time among the included studies of this comparison was 9.8 years (range, 2-18). Furthermore, the mode of delivery (vaginal vs cesarean) did not seem to affect the risk of stress urinary incontinence recurrence. CONCLUSION: Subsequent pregnancy and childbirth did not increase the risk of stress urinary incontinence recurrence or reoperation after a midurethral sling procedure.

Objective: To assess the influence of basal serum levels of luteinizing hormone (LH), total testosterone (TT), and free testosterone (FT) on in vitro fertilization (IVF) success rates in patients with polycystic ovary syndrome (PCOS). Material and Methods: A retrospective cohort analysis of PCOS patients who underwent freeze-all, gonadotropin releasing hormone (GnRH) antagonist IVF protocols from January 2013 to December 2019. Patients were grouped based on median basal serum levels of LH, TT, and FT to compare their IVF outcomes. Results: A total of 76 women with PCOS diagnosed as per the 2003 Rotterdam criteria were included. When analyzed by LH levels, groups had similar baseline characteristics except for higher mean +/- standard deviation TT (1.4 +/- 0.9 vs. 1.9 +/- 0.9 nmol/L, p=0.02) and FT (0.6 +/- 0.5 vs. 0.9 +/- 0.5 nmol/L, p=0.03) in the elevated LH group. However, clinical pregnancy rates (CPR) (34.2% vs. 44.7%, p=0.35) and live birth rates (LBR) (21.0% vs. 31.6%, p=0.29) were not different. The group with lower TT had more previous pregnancies (0.9 +/- 1.2 vs. 0.3 +/- 0.7, p=0.02) and shorter infertility duration (2.3 +/- 2.0 vs. 3.7 +/- 2.7 years, p=0.04), but again CPR (46.8% vs. 42.8%, p=0.90) and LBR (37.5% vs. 25.7%, p=0.33) were similar. FT analysis revealed no significant differences in CPR (48.2% vs. 36.7%, p=0.36) and LBR (23.2% vs. 37.9%, p=0.22) despite higher TT (1.1 +/- 0.4 vs. 2.2 +/- 1.1 nmol/L, p<0.001) and LH (6.1 +/- 3.8 vs. 11.2 +/- 7.2 IU/L, p<0.001) in the high FT group. Conclusion: Basal serum levels of LH, TT, and FT did not significantly affect IVF outcomes in patients with PCOS using GnRH antagonist, freeze- all protocols. (J Turk Ger Gynecol Assoc. 2024; 25: 192-9)

ObjectiveTo develop novel fetal reference ranges for the characterization of the normal appearance of the Sylvian fissures (SF) along gestation and to apply them to fetuses with cortical abnormalities affecting the SF. MethodsIn this cross-sectional study, we used three-dimensional sonographic multiplanar reformatting (3D-MPR) to examine the fetal SF. Normal development was assessed in the second and third trimesters. SF parameters were evaluated in predefined axial and coronal planes: insular height and length, SF depth, and the extent of the coverage of the insula by the frontal and temporal lobes. Intra-observer variability and inter-rater reliability for the studied parameters were evaluated. The new reference charts were applied to 19 fetuses with cortical abnormalities involving the SF who had appropriate sonographic volumes for 3D-MPR analysis. Their diagnoses were confirmed by autopsy, fetal or postnatal MRI, genetic findings related to cortical malformations, or an abnormal cortical imaging pattern with similar MRI findings in an affected sibling. We applied the two previously published references for the evaluation of fetal SF development to these cases and compared the ability of the references to correctly detect SF abnormalities. ResultsThe study included 189 fetuses of low-risk singleton pregnancies between 24 and 34 gestational weeks. The insular length or height increased with gestational age in the axial and coronal planes with adjusted R-2 = 0.621, p R-2 = 0.384, p < 0.0001, respectively. The SF depth also increased with gestational age in the axial and coronal planes with adjusted R-2 = 0.695, p R-2 = 0.219, p = 0.008, respectively. The extent of the coverage of the insula by the frontal and temporal lobes in the coronal plane increased with gestational age (adjusted R-2 = 0.627, p R-2 = 0.589, p < 0.0001, respectively). The interclass correlation coefficients of the intra- and inter-rater reliability of the studied parameters ranged between 0.71 and 0.97. The cortical anomalies in the 19 fetuses were polymicrogyria (7), simplified gyral pattern (3), dysgyria (3), lissencephaly (2), cortical malformation related to tubulinopathy (1), brain atrophy (1), cortical dysplasia (1), and cobblestone malformation (1). Three of the fetuses had multiple cortical anomalies. In 17 of 19 (89%) cases, at least one of our 6 SF parameters was found to be out of the normal range. In the coronal plane, SF height and depth were measured below 2SD in 9 (47%) and 4 (21%) cases, respectively. In the axial plane, SF length and depth were out of the normal ranges in six (31.5%) and four (21%), correspondingly. In the coronal plane, the opercular coverage by the frontal and temporal lobes was below 2 SD in 10 (52%) and 11 (57%), respectively. The scoring of the SF operculization by Quarello et al. was abnormal in 8 cases (42%). The measurement of the SF angle according to Poon et al. was abnormal in 14 cases (74%). ConclusionsThe fetal SF is a complex developing structure that can be reliably characterized by sonographic parameters. One abnormal parameter is sufficient to raise the suspicion of SF malformation. Our new SF parameters might facilitate the detection of prenatal cortical abnormalities affecting the SF.

Breastfeeding (BF), the normative form of nutrition for newborns, may be challanging. While many factors contribute to maintaining BF among parturients, gestational diabetes mellitus (GDM), as diagnosed during pregnancy, is associated with low rates of BF. One hypothesis for the general low rates is the lack of available evidence-based data regarding BF. Our primary outcome was to assess whether an educational videoclip could increase the rates of breastfeeding among parturients, among those with GDM A prospective double-blind randomized controlled trial, of pregnant individuals with GDM. Participants were randomized by 1:1 ratio to study group; receiving a link to an online educational videoclip presented by a multidisciplinary team including an obstetrician, pediatrician, dietitian, and a nurse certified as BF-consultant. Controls received none. The intervention took place at Carmel Medical Center at any time point before delivery while visiting the hospital for unrelated causes (for example- admission to ER, during hospitalization, prior to delivery). After delivery, participants were contacted by telephone and were inquired about the newborn's feeding habits 146 participants with GDM were randomized to the study group (n=70) and control group (n=75). While 96.5% of all participants reported they were intending to BF prior to intervention, only 63.8% reported any BF form (exclusive or formula-combined) upon questioning postpartum. BF rates among the study group (36/54) were similar to the control group (31/50) p-value >0.05. The discrepancy between the intention to breastfeed and BF prevalence, could not be met by mere online videoclip. More research is needed in order to reveal what are the unmet needs of both the mother and infant, so they can be addressed and potentially increase BF rates.

OBJECTIVE To identify and compare long-term predictors for 'surgical failures' in matched groups of METHODS A secondary analysis of patients with urodynamic stress incontinence who were treated either by open BC or retropubic MUS. The study had a cohort of 1344 women with a ratio of 1:3 (BC: MUS). We defined surgical success or failure by combining Patient Reported Outcome Measures and the need for repeat surgery. Risk factors for failure identified by multivariate analysis.RESULTS Of the 1344 women included, 336 had BC, and 1008 had MUS. Patients were followed-up for 13.1 and 10.1 years, and the rate of failure was 22% and 20%, for BC and MUS, respectively (P = 0.35). Significant predictors for MUS failure were Body mass index (BMI) > 30, preoperative anticholinergic medication use, smoking, diabetes, and previous surgery for incontinence (Hazard ratio 3.6, 2.6, 2.5, 1.8, 2.3, respectively). BMI > 25, preoperative use of anticholinergic medication, age > 60, previous surgery for incontinence, and loss of follow-up > 5 years (Hazard ratio: 3.2, 2.8, 2.6, 2.5, 2.1, respectively), were significant predictors of BC failure.CONCLUSION This study shows similar predictors for surgical failure for BC and MUS, with high BMI, mixed urinary incontinence, and previous continence procedures being the most important. UROLOGY 177: 69-73, 2023. (c) 2023 Elsevier Inc. All rights reserved.

OBJECTIVES:To evaluate the effect of overweight (body mass index; BMI 25.0-29.9 kg/m2), and obesity (BMI>30 kg/m2), on the success of trial of labor after cesarean delivery (TOLAC), with consideration of successful past vaginal birth. METHODS:This retrospective cohort study was performed using electronic database of obstetrics department at a university-affiliated tertiary medical center. All women admitted for TOLAC at 37-42 weeks of gestational age, carrying a singleton live fetus at cephalic presentation, with a single previous low segment transverse cesarean delivery between 1/2015 and 5/2021 were included. Primary outcome was the rate of cesarean delivery during labor, and subgroup analysis was performed for the presence of past vaginal birth. RESULTS:Of the 1200 TOLAC deliveries meeting the inclusion criteria, 61.9 % had BMI in the normal range, 24.6 % were overweight (BMI 25.0-29.9 kg/m2), and 13.4 % were obese (BMI of 30 kg/m2 and over). Using a multivariate analysis, BMI≥30 kg/m2 was associated with increased risk of cesarean delivery compared to normal weight. However, in the subgroup of 292 women with a history of successful vaginal birth BMI did not affect TOLAC success. CONCLUSIONS:BMI does not affect the success of TOLAC in women with previous vaginal birth. This information should be considered during patients counselling, in order to achieve a better selection of mode of delivery and higher patients' satisfaction.

To investigate the central projection of nuchal group I afferent fibers of nerves which supply the complexus (COM), biventer cervicis (BIV), splenius (SP), and occipitoscapularis (OCC) muscles, experiments were conducted on cats anesthetized with chloralose-urethane. A total of 246 neurons was found to respond to electrical stimulation of those nerves. Of these neurons, 99.2% were located in the ipsilateral external cuneate nucleus (ECN) and 0.8% in the ipsilateral main cuneate nucleus. Ninety-seven neurons responded only to the BIV, 88 neurons only to the SP, and 56 neurons to the OCC alone. The number of monosynaptically activated neurons from group I fibers were found to be 26 in 97 neurons which responded to the BIV, 20 in 88 neurons responded to the SP, and 8 in 56 neurons which responded to the OCC. The ECN contains these neurons organized in a somatotopic manner. Neurons from distal muscle (the OCC) project to medial parts and from proximal muscle (the BIV) to more lateral parts of the nucleus. Forty-three of the 143 neurons in the ECN (30.1%) were activated antidromically to electrical stimulation of the ipsilateral inferior peduncle and anterior lobules IV and V of the cerebellum. Thalamic responses from nuchal muscle afferent fibers were recorded in a very narrow region of nucleus ventralis posterolateralis (VPL) which is situated dorsolaterally to the forelimb muscle afferent (deep radial nerve) projection area. The cortical evoked potentials from these nerve stimulations were observed in the anterior suprasylvian gyrus, areas 2 or 5, which we regarded as a transitional area between the second somatosensory and association areas, and the postcruciate dimple (PCD) or area 3a. Cortical potentials in the PCD were reduced after lesion of the VPL, where the focal potentials evoked by nuchal muscle afferent stimulation were recorded.

OBJECTIVE: To evaluate maternal and neonatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibody levels at birth after a third (booster) dose of the Pfizer-BioNTech messenger RNA (Pfizer) coronavirus disease 2019 (COVID-19) vaccine during the second trimester of pregnancy, and compare them with those in women who received two vaccine doses during the second trimester. METHODS: We conducted a prospective cohort study of women admitted to the delivery ward at a single center who received the third Pfizer COVID-19 vaccine dose (booster group) at 17-30 weeks of pregnancy and who did not have previous SARS-CoV-2 infection. Maternal and neonatal antibody levels were measured on admission for delivery and in the umbilical cord blood after birth. Antibody levels for the booster group were compared with those in a historical control group of pregnant women who received their second vaccine dose (two-dose group) within the same gestational age window. RESULTS: Between October 2021 and February 2022, antibody levels were measured in 121 women and 109 neonates at a mean +/- SD of 15.3 +/- 3.9 weeks after booster vaccination. Neonatal titers measured two times higher than maternal titers, with inverse correlation between maternal and neonatal titers at birth and time interval from third vaccination. The two-dose group included 121 women and 107 neonates, with antibody levels measured at a mean +/- SD of 14.6 +/- 2.6 weeks after the second dose. Median [interquartile range] maternal antibody titers were higher in the booster group (4,485 [2,569-9,702] AU/mL) compared with the two-dose group (1,122 [735-1,872] AU/mL) (P<.001). Furthermore, neonatal antibody titers were higher in the booster group (8,773 [5,143-18,830] AU/mL) compared with the two-dose group (3,280 [2,087-5,754] AU/mL) (P<.001). CONCLUSION: Maternal and neonatal SARS-CoV-2 IgG antibody titers after second-trimester maternal Pfizer COVID-19 vaccination were significantly higher after the booster dose compared with the two-dose vaccination series. Although there is uncertainty as to whether antibody levels correlate with protection, these data support the importance of booster vaccination during pregnancy to restore maternal and neonatal protection against COVID-19.

Background The COVID-19 outbreak caused persons to be reluctant to seek medical care due to fear of contracting the infection. Objectives To evaluate the effect of the COVID-19 pandemic on admission rates to the delivery room and the feto-maternal unit, and to assess the effect on the nature of presenting obstetrical complaints to the emergency department. Study Design A retrospective cohort study in one medical center. The population was women > 20 weeks pregnant who presented to the obstetrical emergency department with self-complaints during 29 days at the peak of the pandemic outbreak, and a matched group during the exact period in the previous year. We compared between the groups: clinical, obstetrical, and demographic data, including age, area of residence, gravidity, parity, previous cesarean deliveries, high-risk pregnancy follow-up, the last 30 days admissions to the obstetrical emergency department, gestational age, chief complaints, cervical dilatation, cervical effacement, admissions to the delivery room or feto-maternal unit, time from admissions to the delivery room to birth, if applicable, and acute obstetrical complications diagnosed at the emergency department. Results During the pandemic outbreak, 398 women met study inclusion criteria, compared to 544 women in the matched period of the previous year. During the COVID-19 period, women visited the obstetrical emergency department at a more advanced mean gestational age (37.6 +/- 3.7 vs. 36.7 +/- 4.6, p = .001). Higher proportions of women in the COVID-19 cohort presented in active labor, defined by cervical dilation of at least 5 cm on admission to the labor ward [37 (9.3%) vs 28 (5.1%), p = .013)] and with premature rupture of membranes [82 (20.6%) vs 60 (11.0%), p < .001)], and consequently with more admissions to the delivery room [198 (49.7%) vs 189 (34.7%), p < .001)]. We also recorded a significant increase in urgent obstetrical events in the emergency department during the recorded COVID-19 pandemic [23 (5.8%) vs 12 (2.2%)), p = .004]. However, the rates of neonatal and maternal morbidity did not change. During the outbreak the proportion of visits during the night was higher than during the matched period of the previous year: [138 (34.7%) vs 145 (26.6%)), p = .008]. In a multivariate logistic regression, the higher rates of admission to the delivery room during active labor and of urgent events during the pandemic outbreak compared to the matched period in the previous year remained statistically significant. Conclusions The pandemic outbreak of COVID-19 caused a behavioral change among women who presented to the obstetrical emergency department. This was characterized by delayed arrival to the obstetrical emergency department and the delivery room, which led to a significant increase in urgent and acute interventions. The change in behavior did not affect the rates of maternal and neonatal morbidity.

The Biohit SARS-CoV-2 IgM/IgG antibody kit (Biohit Healthcare, Hefei, China) is a novel rapid immunochromatographic test for the qualitative detection of SARS-CoV-2 antibodies in human blood. It is intended to aid in identifying a prior infection within 20 minutes, can be obtained from capillary sampling, and was found to have a sensitivity and specificity of over 95% in the detection of antibodies two weeks after COVID-19 infection in a non-pregnant patient. Our aim was to assess the presence of antibodies at birth by the Biohit rapid test, in women vaccinated during pregnancy with the BNT162b2 mRNA COVID-19 Pfizer vaccine. This prospective observational study included women admitted to the delivery room at least 7 days from their 2nd vaccine and who were not previously infected with COVID-19. Prior to delivery maternal blood was tested by the Biohit rapid test and compared to a quantitative SARS-CoV-2 IgG antibody test taken concomitantly at birth. Between June 2021 and July 2021, 60 women were recruited. Antibody titer levels were measured for 60 women at mean±SD gestational age of 39.1±1.2 weeks with 100% of the tests resulting positive. The mean±SD duration from the 2nd vaccine to delivery was 15.2±2.4 weeks. The median (range) level of IgG antibodies at birth was 1153.1 (146.6-4266.2) AU/ml for the parturients .59 of 60 (98.3%) Biohit rapid tests were positive at birth. The one patient which returned negative on the rapid test received the 2nd vaccine at 21 weeks of gestation, resulting in a time interval 18.1 weeks from the second vaccination to delivey, and had an IgG level of 146.6 AU/ml. The Biohit SARS-CoV-2 antibody qualitative rapid test was found to be accurate among women at birth who were exposed to the mRNA COVID-19 vaccination during pregnancy. Since the rapid test is less expensive, can offer the clinician quicker reliable results from capillary sampling, and can be used with no need for complex settings in laboratories, the use of this novel diagnostic test should be considered in community health care centers and in the developing world.