Umbilical cord prolapse during delivery - risk factors and pregnancy outcome: a single center experience.

OBJECTIVE: To determine the incidence and risk factors for umbilical cord prolapse and to evaluate whether obstetrical interventions increase this risk. METHODS: A retrospective, cohort study of all intended vaginal deliveries in a single tertiary university affiliated medical center (33 519 deliveries). Obstetrical and labor characteristics, including labor interventions [as artificial rupture of membranes (ARM) and intrauterine catheter insertion] and short-term pregnancy outcome were obtained. Primary outcome measure was defined as abnormal umbilical cord pH <7.2 and/or 5-min Apgar score <7. RESULTS: The rate of umbilical cord prolapse was 37/33 519 (0.11%); of them, 23 (62%) were diagnosed after ARM, three cases (8%) were related to external cephalic version and three cases (8%) were related to intrauterine catheter insertion. The rate of umbilical cord pH <7.2 and 5-min Apgar score <7 was higher in the ARM group in comparison to women with spontaneous rupture of membranes (30% versus 21%, p = 0.8). There was no significant difference in mean pH according to mode of delivery. All neonates were discharged within 8 d of delivery with good neonatal outcome and the rate of maternal complications was low. CONCLUSION: Prompt delivery in cases of umbilical cord prolapse is associated with favorable pregnancy outcome.

Novel protocol for scheduling oocyte retrieval in IVM cycles in PCOS patients: a case series.

In-vitro maturation (IVM) is associated with a longer egg-collection procedure in the operating room and a longer oocyte-handling time in the IVF laboratory than standard IVF. Hence, if the designated day of oocyte retrieval could be planned in advance, the workload pressure on that specific day can be planned in advance. This study presents a simple method for advance scheduling of IVM in patients with polycystic ovary syndrome (PCOS). A fixed protocol of oral contraceptive pill administered prior to gonadotrophin priming and based on the days of the week enable the exact dating of the oocyte retrieval day, thereby increasing patient convenience and improving control of the IVF-unit workload. This protocol was compared with immediate-start IVM and resulted in a similar pregnancy rate (43.8% and 40.0% per cycle, respectively).

[Sexual harassment in medical organizations].

Sexual harassment is quite prevalent in medical organizations. The two most affected groups are medical students and nurses. In its broad perspective, sexual harassment is defined as any type of offensive behavior with sexual connotation aimed at any individual or minority. In Israel, sexual harassment is regarded as such only in the literal sense, although recently, courts tend to adopt a more comprehensive approach in their ruling. Final legislation of the law against sexual harassment, which includes employer liability for the actions of its workers, caused increased awareness of the phenomenon of sexual harassment and may serve in reducing its prevalence in the medical environment.

Biochemical terrorism: the medical threat in the twenty-first century.

September 11, 2001, forever changed the landscape surrounding terrorism. The oceans no longer protected the United States from terrorists. And as incidences in the Philippines, Spain, Iraq, and other corners of the globe have found, no place on the planet can be considered risk-free. Unfortunately, not only must the world be concerned with acts of violence and destruction, but also with the threat of a more insidious nature-chemical and biological terrorism. According to a March 29, 2004, article in the New York Times, the Pentagon released parts of an unclassified document suggesting that the United States is "woefully ill-prepared to detect and respond to a bioterrorist assault." In this article, our authors offer us a first-hand window into an important and regrettably necessary area of medicine that could affect us both as physicians and citizens in the twenty-first century.Fig 1 -The Editors Biochemical terrorism-the deliberate dispersion of viruses, bacteria, fungi, and organic or inorganic toxin agents, to kill, mutilate, and create chaos-is a real threat that all countries must cope with today. Both sovereign nations and terror organizations now have the capability to produce and use biochemical agents, and some of them have already demonstrated their eagerness to do so. The development of instant communication has been a further inducement to the terrorists. Each event is reported almost immediately in the media, bringing recognition and reputation to the executors (1-3).