Objective: The purpose of this study was to discover whether performing a routine prior-to discharge ultrasound after manual exploration of the uterine cavity identified findings that led to interventions and reduced postpartum complications. Design: Retrospective multicenter cohort study was conducted between 2013 and 2019. Setting: Tzafon medical center and Emek medical center, Israel Population or Sample: Among 1780 women, who underwent manual exploration of the uterine cavity, 784 belonged to the routine ultrasound group and 996 belonged to the clinically indicated ultrasound group. Methods: A comparison was made between two medical center’s protocols according to which all women underwent a routine ultrasound after manual exploration of the uterus prior-to discharge (Tzafon medical center protocol) versus performing ultrasound only if clinically indicated (Emek medical center protocol). Main outcome Measures: The primary outcome included a composite of late post-partum hemorrhage, endometritis, uterine curettage and hysteroscopy to remove products of conception. Results: In comparison between the routine ultrasound group and the clinically indicated ultrasound group, more women had abnormal sonographic findings ((74 (9%) versus 20 (2%), respectively; P=0.0001), more interventions, particularly uterotonics administration (34 (4%) versus 6 (0.6%), respectively; P=0.0001) without a different in the composite outcome (27 (3%) versus 41 (4%), respectively; P=0.46). Conclusion: Conducting prior-to discharge ultrasound scan routinely after manual exploration of the uterine cavity led to more interventions without benefit regarding long-term outcomes. Therefore, this study supports conducting an ultrasound after manual exploration of the uterus only if clinically indicated.

Objective: To explore maternal humoral immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the rate of vertical transmission. Design: A prospective cohort study. Setting: Two university-affiliated medical centers in Israel. Population: Women positive for SARS-CoV-2 reverse-transcription-polymerase-chain-reaction (RT-PCR) test, during pregnancy were enrolled just prior to delivery. Methods: Levels of anti-SARS-CoV-2 spike-IgM, spike-IgG and nucleocapsid-IgG were tested in maternal and cord blood at delivery, and neonatal nasopharyngeal swabs were subjected to PCR testing. Main outcomes measures: The primary endpoint was the rate of vertical transmission, defined as either positive neonatal IgM, positive neonatal IgG with sero-negative mother or positive neonatal PCR. Results: Among 72 women, 36 (50%), 39 (54%) and 30 (42%) were positive for anti-spike-IgM, anti-spike-IgG and anti-nucleocapsid-IgG, respectively (p<0.0001 for IgG antibodies-comparison). At least 8/72 (11%) neonates were infected in utero; one had a positive PCR result and seven had positive IgG antibodies while their mothers were seronegative for the same IgG. IgM was not detected in cord blood. Anti-nucleocapsid-IgG and anti-spike-IgG were detected in 83% and 85% of neonates of seropositive mothers, respectively (Pearson coefficient correlation 0.8, p<0.001). The highest rate of positive maternal serology tests was 8-12 weeks post-infection (89% anti-spike IgG, 78% anti-spike-IgM and 67% anti-nucleocapsid-IgG). Thereafter, the rate of positive serology tests declined gradually; at 20 weeks post-infection, only anti-spike-IgG was detected in 33-50%. Conclusions: The rate of vertical transmission was at least 11%. Vaccination should be considered 3 months post-infection in pregnant women due to a decline in antibody levels.

Background Several adjuvant interventions have been evaluated for improving the success rate of external cephalic version (ECV) and reduce the rate of cesarean delivery (CD). Evidence regarding the effect of Nitrous oxide (NO) is limited with inconsistent results on pain score and success rate. Objective To examine the effect of inhaled NO on the success rate and pain score for women undergoing ECV. Search strategy MEDLINE, EMBASE, PubMed, Ovid Medline, ClinicalTrials.gov, the Cochrane Library and Google Scholars from inception till June 2020. Selection criteria Peer-review studies that examined the success rate of inhaled NO use during ECV attempt compared with or without the use of other analgesic agents were eligible for inclusion. Data collection and analysis All ascertained records were screened independently for eligibility by two authors. The study quality scores were evaluated as a source of heterogeneity by fitting meta-regression models to the individual study effect sizes. Results Of the 186 records, two randomized trials and one prospective cohort study (434 in the NO group and 286 in the controls) were deemed adequate for meta-analysis. ECV success rate did not differ significantly between the NO and the controls group (p=0.825; OR 1.036; 95% CI, 0.756-1.419). In addition, the use of NO did not affect pain scores (p=0.457; OR 0.759; 95% CI, -1.240-2.759) and there was no difference in the incidence of CD (p=0.943; OR 1.013; 95% CI, 0.703-1.46). Conclusion Use of NO during ECV is not associated with increase in ECV success rate and does not affect pain score.