Objective: To determine whether preterm twins who receive antenatal corticosteroid (ACS) are at increased risk for developing neonatal hypoglycemia. Design: A retrospective cohort study Setting: Single university-affiliated tertiary referral center Population: Indicated and spontaneous preterm births (24+0-36+6 weeks) at a single center between 2011-2018. The study population included 3 groups matched for gestational age at delivery and birth weight: 1. Twin neonates who received a course of ACS 1-7 days before birth (n=266); 2. Twins who did not receive ACS at that time interval (n=266); and 3. Singletons receiving ACS 1-7 days before birth (n=266). Methods: The rate of neonatal hypoglycemia was determined. Parametric, non-parametric statistical methods, and regression analysis, were employed. Main outcome measures: Neonatal hypoglycemia (<40 mg/dL) within the first 24-h and 48-h of life. Results: The rate of neonatal hypoglycemia during the first 24-h of life was significantly higher in singletons exposed to ACS compared to twins not exposed to ACS (p=0.019) and in twins exposed to ACS compared to twins not exposed to ACS (p=0.047). The rate of neonatal hypoglycemia was almost identical between twins and singletons exposed to ACS (40.6% vs. 42.1%,p=0.72). Regression analysis revealed that exposure to ACS (p=0.027) and birth weight (p=0.009) were independently associated with neonatal hypoglycemia after adjustment for maternal age, maternal BMI, gravidity, GDM diagnosis, and GA at delivery. The rate of neonatal hypoglycemia between 24-48 hours after birth did not differ significantly among groups (p=0.068). Conclusions: Exposure to ACS, rather than plurality, is associated with short-lived neonatal hypoglycemia

Objective- To assess maternal endothelial function in singleton pregnancies complicated by intrauterine growth restriction (IUGR) due to placental dysfunction. Design- Prospective cohort study. Setting- 37 pregnant women who underwent endothelial function assessment using EndoPATTM device. Population or Sample- Study population included two groups: 1. Pregnancies with estimated fetal weight below 10th percentile and abnormal umbilical artery flow (n=15); 2. Pregnancies with normal fetal growth without placental complications matched by gestational age (n=22). Exclusion criteria included diseases with potential vascular dysfunction or smoking. Methods- EndoPAT device evaluates changes in peripheral vascular flow and tone in reaction to temporal ischemia. Normal post-ischemic endothelial reaction is an increase in vascular flow. A ratio of the readings before and after ischemia is used to calculate the score for endothelial function, called reactive hyperemic index (RHI). Low RHI value indicates endothelial dysfunction. Main outcome measures- RHI values. Results- Mean gestational age at endoPAT examination was comparable between the IUGR and control group (32.5 ± 2.2 vs, 31.6 ± 3.2, respectively; p=0.21). Mean RHI was significantly lower in the IUGR group compared to the control group (1.32 ± 0.16 vs 1.51 ± 0.31, p= 0.02, respectively). As expected, mean gestational age at delivery and neonatal birth weight were lower in the IUGR group compared to the control group (35.4 ± 2.3 vs 37.3 ± 2.6 p=0.04; 1640 ± 414 grams vs 2785 ± 587 grams, p<0.001 respectively). Conclusions- Pregnant women with isolated IUGR due to placental dysfunction had impaired endothelial function.

Objective: Estimated fetal weight, large for gestational age (eLGA) (≥90th percentile) may be associated with failed trial of labor after Cesarean (TOLAC), like fetal macrosomia. The aim of this study was to evaluate obstetrical outcome and safety of TOLAC, for women with eLGA. Design: A retrospective cohort study. Setting: a single large tertiary care center. Population or Sample: all women with singleton pregnancy, gestational age ≥ 37weeks, admitted for TOLAC between 2012 and 2017. Methods: Women with eLGA were compared to women with EFW < 90th percentile. Main outcome measures: the rate of successful vaginal delivery, adverse obstetrical outcomes. Results: 1949 women met inclusion criteria, including78 (4%) eLGA and 1871 (96%) controls. Study group were older (35 vs. 33 year; p=0.004), with higher Body Mass Index (30.9 vs. 27.5 kg/m2; p=0.001) and higher gravidity (4 vs. 3; p=0.001) compared to the controls. Median fetal weight was [3887g (IQR 3718-4073) vs. 3275g (IQR 2995-3545); p=0.001 in the study vs. controls respectively]. 55 (70.5%) women in the study group had successful vaginal delivery compared to 1506 (80.5%) women in the control (p= 0.03). The rate of obstetrical complications, including: scar dehiscence, uterine rupture, 3rd /4th degree perineal tear or shoulder dystocia were comparable. The rate of post-partum hemorrhage was increased in the study group compared to controls (7.7% vs.1.7%; p=0.001). Conclusion: TOLAC for eLGA fetuses can be considered as safe, however, lower successful VBAC rates and increased PPH rate may be expected.