Maternal carriage and vertical transmission of extended-spectrum, beta-lactamase-producing Enterobacteriaceae (ESBL-E), such as Escherichia coli, hamper the treatment of infections, resulting in high morbidity. E. coli is the most frequent cause of early-onset neonatal sepsis (EOS) in preterm infants, where ESBL-E are more frequently isolated. In this prospective, case-controlled study, maternal rectovaginal ESBL-E colonization and vertical transmission to preterm infants were assessed in 160 women with preterm premature rupture of membranes (PPROM; 57.4%) or preterm labor (42.6%); additional cultures were obtained from the placenta, amnion, and umbilical cord during preterm labor. Maternal and neonatal ESBL-E-carriage rates were 17.5% and 12.9%, respectively, and the vertical-transmission rate was 50%. Maternal ESBL-E colonization among women with PPROM was 21.3%, and in women with premature labor it was 12.6%. No correlation was observed between maternal ESBL-E-colonization and previous hospitalization or antibiotic administration during pregnancy. However, a correlation was found between placental inflammation and maternal ESBL-E colonization (p = 0.007). ESBL-E-colonized infants were delivered at an earlier gestational age and were more likely to have complications. Thus, the high ESBL-E carriage rate in women with threatened preterm labor, without obvious risk factors for carriage, and a high vertical transmission rate, combined with a correlation between placental inflammation and ESBL-E carriage, support maternal–neonatal ESBL-E-colonization surveillance and active measures to prevent ESBL-E-related EOS.

Importance: Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes. Objective: To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus. Evidence Acquisition: PubMed was searched for the phrases “uterine rupture,” “unscarred,” and “spontaneous.” Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included. Results: We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries. Conclusions and relevance: Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy. Target Audience: Obstetrician-gynecologists, family medicine physicians. Learning Objectives: After completing this activity, the learner will be better able to describe the consequences of spontaneous rupture of the unscarred uterus to the mother and fetus; discuss risk factors for spontaneous rupture of the unscarred uterus and its potential occurrence in nulliparous, antepartum, and the first trimester; and discuss how timely assessment of a pregnant woman presenting with abdominal pain impacts survival of the mother and child.

Objective: To evaluate real-world prescribing patterns of low-dose aspirin for preeclampsia prevention among pregnant women who met the Israeli or American College of Obstetricians and Gynecologists (ACOG) guideline criteria for preeclampsia prophylaxis, and to identify disparities and missed opportunities in implementing risk-based prophylaxis in a diverse obstetric population. Methods: This retrospective study analyzed women who delivered live births at a tertiary medical center in northern Israel between March 2020 and April 2024. Eligibility for low-dose aspirin prophylaxis was assessed using Israeli guidelines, focusing on major risk factors, and the broader ACOG criteria, which include moderate-risk factors. This dual approach reflects debates in Israel about incorporating moderate-risk factors into routine clinical practice. Results: Of 18,838 women included, 1,160 (6.2%) met the criteria for low-dose aspirin prophylaxis under Israeli guidelines, and 511 (44.1%) of these received prescriptions. The prescription rate was highest among women with a history of preeclampsia (79.0%) and pregestational diabetes (66.3%) but notably lower among those with chronic hypertension (30.3%) and autoimmune diseases (41.3%). Under ACOG criteria, 2,559 women (13.6%) were eligible for low-dose aspirin, but only 27.9% (715/2,559) received prophylaxis. The prescription rate was significantly higher among women with high-risk factors than among those with only moderate-risk factors (OR=0.16, p< 0.001). Arab women were more likely to receive low-dose aspirin than were Jewish women (31.2% vs 24.5%, p< 0.001), consistent with higher prevalences of risk factors. Multivariate analysis showed that a history of preeclampsia (OR=7.15, p< 0.001) and pregestational diabetes (OR=3.80, p< 0.001) were strongly associated with low-dose aspirin prescription. Conclusion: Our findings reveal suboptimal prescription of low-dose aspirin according to guideline criteria, especially among women with moderate-risk factors. Even among women with high-risk factors, disparities in prescribing practices persisted. These gaps highlight the need for better provider education, consistent risk assessment, and structured implementation strategies to improve guideline adherence.

Objectives: Retained products of conception (RPOC) can occur after delivery, abortion, or uterine evacuation, presenting diagnostic challenges. This study aimed to assess the diagnostic accuracy of transvaginal ultrasound (TVS) endometrial thickness measurements for identifying RPOC and propose tailored hysteroscopic management strategies. Design: This is a retrospective cohort study. Participants and Setting: A total of 226 women with suspected RPOC underwent hysteroscopy between 2018 and 2021 at the Galilee Medical Center. Methods: Endometrial thickness was measured by TVS, and diagnostic metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated. Results: The mean endometrial thickness was 1.6 cm (0.7–6 cm). The overall PPV for RPOC was 79.2%, with a false-positive rate of 20.7%. A cut-off of 1.49 cm yielded a sensitivity of 69.8%, specificity of 59.6%, PPV of 86.8%, and NPV of 34.1%. Women with thickness >1.49 cm had a threefold increased likelihood of RPOC. Stratifying by endometrial thickness showed PPVs of 54.5% (20 mm). Limitations: Retrospective design may introduce selection bias, and findings require validation in larger, prospective studies. Conclusions: An endometrial thickness above 1.49 cm significantly increases the likelihood of RPOC confirmation. RPOC can occur in asymptomatic women with associated risk factors. TVS endometrial thickness measurements are effective for diagnosing and managing these cases, and stratification further enhances diagnostic accuracy.

Objectives: Intrahepatic cholestasis of pregnancy (ICP) is charachterized by pruritis and elevated serum bile acids (BA) and is associated with adverse obstetrical outcomes. ICP etiology is poorly understood and its incidence varies with ethnicity and geographical distribution. Objectives: Explore the prevalence and characteristics of ICP in the different Northern Israeli ethnic groups and compare maternal and perinatal outcomes according to disease severity. Material and methods: Single-center retrospective study. Women who were diagnosed with ICP based on clinical presentation and elevated fasting BA (≥ 10 μmol/L) were included. Disease incidence, maternal and neonatal complications were explored according to ethnic subgroups analysis and obstetrical complications were examined according to disease severity. Results: The incidence of ICP in the study population was 0.58%. Higher ICP incidence was found in our cohort compared with other reports arising from Central Israel (p < 0.001). The Christian patients had a higher incidence of ICP (1.1%) and preeclampsia (23.1%). A higher rate of neonatal intensive care unit (NICU) admissions was found in the Arab Muslim and Christian groups compared with the Jewish and Druze groups (p = 0.007). A higher rate of preeclampsia was found in the severe (BA ≥ 40 μmol/L) ICP group (p < 0.001). Patients in the severe ICP group had earlier gestational age at delivery (37 versus 38.14 weeks, p < 0.001). Birth weight was significantly lower in the severe ICP group (p = 0.018). Conclusions: The incidence of ICP at our institution was 0.58%, which is higher compared with previous reported Israeli incidence. Higher ICP and preeclampsia incidence were found among Arab Christian patients. Objectives: Intrahepatic cholestasis of pregnancy (ICP) is charachterized by pruritis and elevated serum bile acids (BA) and is associated with adverse obstetrical outcomes. ICP etiology is poorly understood and its incidence varies with ethnicity and geographical distribution. Objectives: Explore the prevalence and characteristics of ICP in the different Northern Israeli ethnic groups and compare maternal and perinatal outcomes according to disease severity. Material and methods: Single-center retrospective study. Women who were diagnosed with ICP based on clinical presentation and elevated fasting BA (≥ 10 μmol/L) were included. Disease incidence, maternal and neonatal complications were explored according to ethnic subgroups analysis and obstetrical complications were examined according to disease severity. Results: The incidence of ICP in the study population was 0.58%. Higher ICP incidence was found in our cohort compared with other reports arising from Central Israel (p < 0.001). The Christian patients had a higher incidence of ICP (1.1%) and preeclampsia (23.1%). A higher rate of neonatal intensive care unit (NICU) admissions was found in the Arab Muslim and Christian groups compared with the Jewish and Druze groups (p = 0.007). A higher rate of preeclampsia was found in the severe (BA ≥ 40 μmol/L) ICP group (p < 0.001). Patients in the severe ICP group had earlier gestational age at delivery (37 versus 38.14 weeks, p < 0.001). Birth weight was significantly lower in the severe ICP group (p = 0.018). Conclusions: The incidence of ICP at our institution was 0.58%, which is higher compared with previous reported Israeli incidence. Higher ICP and preeclampsia incidence were found among Arab Christian patients.