The study objective was to evaluate the added-value of fetal brain MRI to ultrasound examination in detecting and specifying callosal anomalies, and its impact on clinical decision making. Fetuses with a sonographic diagnosis of an anomalous corpus callosum (CC) who underwent a subsequent fetal brain MRI between 2010 and 2015 were retrospectively evaluated and classified according to their findings' severity. Comparison of the findings detected on ultrasound to those detected on MRI was performed. An analysis was made to assess whether the addition of fetal MRI altered the group classification, and thus the management of these pregnancies. 78 women were recruited following sonographic diagnosis of either complete or partial callosal agenesis, short, thin or thick CC. Normal MRI studies were obtained in 19 cases (24%). Analysis of the concordance between US and MRI demonstrated a good level of agreement for complete callosal agenesis (kappa: 0.742), moderate agreement for thin CC (kappa: 0.418) and fair agreement for all other callosal anomalies. Comparison between US and MRI based mild/severe findings classifications revealed that for 28 fetuses (35.9%) MRI altered the initial ultrasound based classification. Following MRI, the classification of 25 fetuses (32.1%) changed from severe to mild findings while the classification of 3 fetuses (3.8%) changed from mild to severe findings. Fetal MRI effectively detects callosal anomalies and enables satisfactory validation of the occurrence or absence of callosal anomalies identified by ultrasound and adds valuable data that improves clinical decision making.
Abstract Background Pregnant women commonly sustain injuries following traffic collisions, falls, and intentional incidents such as domestic violence. Injuries sustained by pregnant women can lead to placental abruption, pelvic fracture, preterm delivery as well as maternal and fetal mortality. The aim of this study was to compare injury and hospitalization characteristics among hospitalized pregnant and nonpregnant women. For pregnant women, gestational age was analyzed according to injury severity and hospitalization characteristics. Methods The Israel National Trauma Registry was the data source for this retrospective study. Demographic, injury and hospitalization characteristics were collected and analyzed for pregnant and nonpregnant women hospitalized between Jan 1, 2012 and December 31, 2021. Among pregnant females, gestational age was identified. Categorical variables were compared using the Chi-square Test and Fisher's Exact Test. Results A total of 33,377 women, aged 18–45 years, were hospitalized due to trauma-related injury; 14,606 (43.8%) were pregnant, and 18,771 (56.2%) were not pregnant. Among the pregnant women, 91.7% had an Injury Severity Score (ISS) of 1, and 75.9% were hospitalized for a single day. In comparison, 31% of the nonpregnant women had an ISS of 1 (X2 = 12,371.26, df = 1, P < 0.0001), and 32% were hospitalized for one day. Traffic accidents contributed to 51.8% of hospitalizations among pregnant women, compared with 42.8% among nonpregnant women. While falls were more prevalent among pregnant women, a greater proportion of nonpregnant women were hospitalized with intentional injuries. Among pregnant women, injuries during the third trimester are most common. However, those hospitalized during the first trimester suffered from more severe injuries than injuries during the second and third trimesters did. Compared with nonpregnant women, pregnant women are more likely to sustain minor injuries, have shorter hospitalization stays, have fewer surgical interventions and have fewer admissions to intensive care units (ICUs). Conclusions This study provides important data for medical personnel and policymakers regarding trauma-related injuries among pregnant women. The results highlight the need to construct effective prevention and treatment protocols and criteria for hospitalizing injured women during pregnancy. A multidisciplinary team of experts, including neonatal and obgyn physicians should design criteria for hospital observation and discharge in an effort to prevent any adverse events while also avoiding unnecessary hospitalization.
Estimation of amniotic fluid volume (AFV) is part of routine obstetric sonography which reflects maternal-fetal circulation efficiency, fetal hemodynamic status, and a parameter for predicting adverse neonatal outcome. Fetal weight is positively correlated with AFV. Therefore, our objective is to provide a new nomogram of AFV indices and to evaluate the relation between AFV and fetal biometric parameters.Retrospective cohort study between 2011 and 2018, at a large tertiary medical center. Data were collected from medical charts of prenatal sonographic evaluation of normal pregnancies, including routine estimation of AFV by using amniotic fluid index (AFI). Generalized estimating equations model was used to study the association between AFI, gestational age and fetal biometric parameters. Centiles were calculated using the Generalized Additive Models for Location, Scale, and Shape model. Box-Cox-t distribution and smoothing splines were used.Analysis included 28,650 pregnancies. From 25 to 41 weeks gestation, the median and fifth percentile AFI gradually decreased from 174 (IQR 157-193) to 138 mm (IQR 107-173) and from 125 to 68 mm, respectively. The change in the 95th percentile was less significant, ranging around 230 mm throughout pregnancy. Multivariate regression analysis demonstrated a significant correlation between AFI and maternal body mass index (B = -0.147; CI = -0.27 to -0.02), gestational age (B = -11.8; CI = -12.5 to -11.4), estimated fetal weight (EFW) (B = 0.05; CI = 0.049-0.053) and abdominal circumference (AC) (B = 0.94; CI = 0.95-1). There was no correlation between AFI and other fetal biometric parameters.We suggest new AFI indices of singleton pregnancies. We found a positive correlation between AFI and EFW and AC.
Introduction: There are two most popular protocols for Frozen Embryo Transfer: the natural and the E2&P4 replacement cycles. There is still a controversy whether one is superior over the other.Purpose: To compare the outcome in patient groups undergoing FET following these protocols.Methods: About 1235 FET cycles were retrospectively analyzed during a period of 12 years. In 798 cycles (group A), the natural cycle protocol was used, and in 437 cycles (group B), the exogenous E2&P4 administration protocol was used.Results: The average patient age was 32.11 ± 0.27 years in group A and 32.94 ± 0.19 years in group B (p < 0.05). The endometrial thickness was 9.54 ± 0.11 mm and 8.95 ± 0.13 mm in groups A and B, respectively (p < 0.001). The peak serum E2 level was 162.51 ± 8.97 pg/mL and 250.78 ± 33.67 pg/mL in groups A and B, respectively (p < 0.001). The implantation, clinical pregnancy, and ongoing pregnancy rates in groups A and B were 6.47%, 12.91%, and 10.4% versus 4.26%, 8.47%, and 5.95%, respectively (p < 0.05).Conclusions: Natural endometrial preparation yields better outcome in compare with exogenous E2&P4 in FET cycles with higher endometrial thickness, implantation, and clinical pregnancy rates.
Little is known about the advantages of Diffusion Tensor Imaging (DTI) when evaluating the fetal corpus callosum (CC), a sensitive indicator for normal brain development. This study evaluates the contribution of DTI compared to T2-weighted imaging to assess fetal CC biometry.
In the complex landscape of modern warfare, understanding combat-related injuries leading to hospitalization is crucial for optimizing injury treatment. This study aims to compare combat casualty characteristics and outcomes during the major conflicts between Israel and Hamas in 2023 and 2014 as a basis for understanding the effectiveness of trauma care practices for wounded soldiers. A cohort study of soldiers hospitalized due to combat injuries during two major wars between Israel and Hamas in 2023 and 2014, using data from the Israeli National Trauma Registry. This study did not include deaths before hospital arrival or casualties who were discharged from the Emergency Department. Of the 1,198 study subjects, 67.8% belonged to the 2023 cohort and 32.2% to the 2014 cohort. The percentage of casualties with severe and critical injuries (Injury Severity Score [ISS] 16–75) was higher among the 2023 cohort (18.6% vs. 13.7%, p = 0.036), as was the percentage of casualties with multiple severe injuries (≥ 2 regions with Abbreviated Injury Score ≥ 3: 11.5% vs. 7.5%, p = 0.035) and firearm injuries (19.6% vs. 14.5%, p = 0.081). Injuries to the torso and extremities were more frequent among the 2023 cohort. Among the critically injured casualties (ISS 25–75), the mortality rates were 17.3% vs. 28.6%, respectively, for the 2023 and 2014 cohorts (p = 0.351); adjusted HR (95% CI): 0.56 (0.21–1.49). The 2023 cohort had higher rates for treatment in the trauma bay (61.5% vs. 47.9%, p < 0.001), ICU utilization (admission: 16.3% vs 11.7%, p = 0.036), surgical intervention (51.5% vs. 42.7%, p = 0.005), longer duration from arrival to surgery (median [interquartile range]: 4.6 (1.2–18.5) vs. 2.6 (1.1–10.1) hours, p = 0.037), and longer hospital stays (> 14 days: 15.5% vs. 8.8%, p < 0.001). Our data demonstrated that more casualties who survived to hospital arrival were severely and multiply injured in the 2023 Israel-Hamas war as compared to the 2014 war. Despite the increased severity, in-hospital survival did not worsen though there was an increase in hospital resource utilization.
OBJECTIVE Intracranial pressure monitoring (ICPM) is a cornerstone procedure in the management of severe traumatic brain injury (TBI). Yet, its implementation is low and the impact on outcomes debated. The authors’ objective was to determine the association between ICPM and 1-year mortality in severe TBI. METHODS The authors performed a retrospective cohort study utilizing data from the Israel National Trauma Registry (INTR) of severe TBI patients admitted to level I trauma centers from 2015 to 2021. Multivariable logistic regressions were performed to calculate the odds ratio (OR) of 1-year mortality, adjusted for age, Glasgow Coma Scale (GCS) score, other severe injuries (nonhead Abbreviated Injury Scale [AIS] score ≥ 4), hypotension, and surgical decompression. The main outcome was 1-year mortality. RESULTS Of 2202 patients, 36.8% underwent insertion of ICPM. ICPM patients had a lower 1-year mortality rate (28.12% vs 33.60%, p = 0.015). Compared with ICPM, the adjusted odds of 1-year mortality of no ICPM were increased 1.2-fold (OR 1.21, 95% CI 0.96–1.54). The effect size was greater among patients with head AIS score 5–6 and age 18–64 years (OR 1.57, 95% CI 1.13–2.20) and age ≥ 65 years (OR 1.92, 95% CI 1.04–3.55); the effect size of no ICPM in those with head AIS score 3–4 was decreased (OR 0.49, 95% CI 0.26–0.93). CONCLUSIONS A significant association between ICPM and lower 1-year mortality in the most severe TBI patients (head AIS score 5–6) who were ≥ 18 years of age was observed. The authors’ study supports the use of ICPM in severe TBI. The authors recommend more detailed reporting to best inform quality improvement programs on a national scale. This research contributes to the academic dialogue on TBI and the considerations for enhancing patient care.
