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Biomedical subjects

D Peleg

Publications and source records attributed to D Peleg.

At least 55 records · Page 3Linked to original sources
PubMed1996

Uterine activity after betamethasone administration for the enhancement of fetal lung maturation.

OBJECTIVE: To assess the effect of steroids administered for the enhancement of fetal lung maturation on uterine activity. DESIGN: A retrospective analysis. SETTING: High-risk Pregnancy Unit, Golda Medical Center, Petah Tikvah, Israel. PATIENTS: Fifty-nine courses of betamethasone therapy prescribed for various indications other than premature contractions were studied in 29 pregnant women at 26-34 weeks' gestation. MEASUREMENTS: Uterine activity was monitored on the day of the first (but prior to) beta-methasone injection, then daily for the next 3 consecutive days. The number of uterine contractions during the first 30 min of each tocodynamometric tracing was assessed. RESULTS: The frequency of uterine activity after steroid administration is significantly higher in multiple pregnancies as compared to singletons, and significantly increases as the duration of pregnancy increases. However, labor was not induced and all women delivered at least 1 week after the last betamethasone injection. CONCLUSIONS: Since the increased uterine activity after administration of steroids for the enhancement of fetal lung maturation does not provoke labor, it is suggested that this increase in uterine activity seems to act as a temporary phenomenon. Therefore conservative management, rather than tocolysis, would seem appropriate.

Adult↗
PubMed1996

Severe ovarian hyperstimulation syndrome despite low plasma oestrogen concentrations in a hypogonadotrophic, hypogonadal patient.

Ovarian hyperstimulation syndrome (OHSS) is the most serious, life-threatening, iatrogenic complication of ovulation induction. The importance of excessive oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration as a predictor and factor in the pathophysiology of OHSS has been extensively studied and discussed. We present the case report of a woman with hypogonadotrophic hypogonadism who developed severe OHSS during ovulation induction with urinary human follicle stimulating hormone (FSH) and HCG in the presence of low circulating oestradiol concentrations. The implication of FSH treatment and complications in hypogonadotrophic hypogonadal patients, and the role of preovulatory oestradiol concentrations in the prediction of OHSS, are discussed.

Adult↗
PubMed1995

Comparison of 12- and 72-hour expectant management of premature rupture of membranes in term pregnancies.

OBJECTIVE: To compare 12-hour and 72-hour expectant management of premature rupture of membranes (PROM) in singleton term pregnancies. METHODS: In a prospective, nonrandomized study, 566 low-risk women with singleton term pregnancies presenting with PROM were assigned to either 12-hour or 72-hour expectant management. Patients who had not entered labor at the end of the assigned period were induced with oxytocin. The pregnancy outcome of both methods was compared with regard to infectious complications and method of delivery. RESULTS: There was no statistical difference in the rate of chorioamnionitis between the 12-hour and 72-hour expectant management groups (11.7 versus 12.7%; relative risk [RR] 0.9, 95% confidence interval [CI] 0.6-1.5; P = .83). Cesareans were performed to a similar degree in both groups (4.7 versus 6.7%; RR 0.7, 95% CI 0.3-1.4; P = .39). Fifty-five percent of the 12-hour group underwent oxytocin induction, compared with 17.5% of those in the 72-hour group (RR 5.8, 95% CI 3.9-8.5; P < .001). Women undergoing induction after 72-hour expectant management had an increased risk of cesarean delivery compared with those after a 12-hour wait (RR 5.9, 95% CI 2.3-15.1; P < .001). Overall, women in the 12-hour group had shorter admission-to-discharge times than the 72-hour group (5 versus 6 days, 95% CI of the difference 0.6-1.3; P < .01). CONCLUSION: Regimens of 12-hour and 72-hour expectant management of PROM are comparable regarding infectious complications and pregnancy outcome. However, the longer wait prolongs the interval to delivery and increases hospitalization costs.

Adolescent↗
PubMed1995

Spontaneous resolution of ectopic tubal pregnancy: natural history.

OBJECTIVE: To determine the characteristics and long-term outcome of women succeeding or failing expectant management of ectopic pregnancy (EP). DESIGN: Prospective, defined protocol. SETTING: University-affiliated gynecology department. PATIENTS: We used a protocol that selected women with laparoscopic confirmed ectopic tubal pregnancy and declining plasma hCG values. Over a 5-year period, 60 women representing 20.1% of EPs fulfilled the inclusion criteria. Women were followed with serial hCG testing and transvaginal ultrasound. MAIN OUTCOME MEASURE: Success or failure of expectant management. RESULTS: Expectant management was successful in 28 (47.7%) of the patients. Thirty-two (53.3%) failed expectant management, and a treatment procedure was required. There was no difference in the resultant ipsilateral tubal patency or 1-year fertility rates of those women succeeding or failing expectant management. Analysis showed that in the face of declining values and with a starting hCG > 2,000 mIU/mL (conversion to SI unit, 1.00), 93.3% failed expectant management, whereas < 2,000 mIU/mL, 60.0% succeeded. CONCLUSION: We conclude that expectant management should be offered as a treatment option only in those women fulfilling the criteria for a good prognosis.

Adnexa Uteri↗
PubMed1995

Limited role for intratubal methotrexate treatment of ectopic pregnancy.

OBJECTIVE: To test the effectiveness of laparoscopic intratubal methotrexate (MTX) injection or salpingostomy in the treatment of ectopic pregnancy (EP). DESIGN: Prospective predefined protocol. SETTING: Department of Obstetrics and Gynecology of a university-affiliated hospital. PATIENTS AND INTERVENTIONS: Between January 1988 and December 1993, we treated 342 women with EP, of which 99 were treated by either laparoscopic salpingostomy (n = 55) or intratubal MTX injection (n = 44). MAIN OUTCOME MEASURES: The success and failure rates were calculated for each treatment protocol. Also analyzed were subsequent tubal patency and fertility rates. RESULTS: Salpingostomy was successful in 51 of 55 patients (92.7%), whereas intratubal MTX injection was successful in only 27 of 44 women (61.4%). Methotrexate injection particularly was unsuccessful if the initial hCG was > 2,000 mIU/mL (conversion factor to SI unit, 1.00) or the size of the tubal mass was > 2.0 cm as measured during laparoscopy. There was no difference in the subsequent tubal patency rates of fertility rates between women undergoing MTX injection or salpingostomy. CONCLUSIONS: These results suggest that salpingostomy is effective in the treatment of EP. Methotrexate injection failed in more patients despite preferential selection criteria, suggesting that its use should be limited to the subgroup of women with initial hCG < 2,000 mIU/mL and size at laparoscopy < 2.0 cm.

Adult↗
PubMed1995

Recovery of ovarian function after laparoscopic detorsion.

In an attempt to preserve ovarian function, we managed 58 women with adnexal torsion by laparoscopic detorsion. Follow-up ultrasound examinations were performed on 54 of the women. Follicular development was evident in 49 of 52 (94.2%) women with normal-sized ovaries. We conclude that ovarian function returns in the majority of women with adnexal torsion managed conservatively.

Adnexal Diseases↗
PubMed1995

Use of cordocentesis in the management of preterm or growth-restricted fetuses with abnormal monitoring.

The dilemma of when to deliver preterm or growth-restricted fetuses with abnormal monitoring is faced by all those treating such patients. Current noninvasive tests for fetal well-being have relatively high false-positive rates. Cordocentesis allows the clinician to directly analyze fetal blood and determine whether the fetus is truly in distress, is suffering from aneuploidy, or is plagued by infection. However, with improved neonatal care, otherwise normal infants of birth weight greater than 1500 gm have very low morbidity and mortality rates and any delay in delivery offered by cordocentesis is probably not justified. It is in the fetus whose estimated weight is below 1500 gm that cordocentesis should be used. If the results are normal, expectant management and the administration of corticosteroids will allow for pulmonary maturation and a more favorable outcome.

Cordocentesis↗
PubMed1995

Laparoscopic unwinding of hyperstimulated ischaemic ovaries during the second trimester of pregnancy.

Successful unwinding of large, hyperstimulated, ischaemic-haemorrhagic adnexa by laparoscopy during the second trimester of pregnancy is described. Three women in their second trimester of pregnancy were treated by laparoscopy. In all cases, the ovaries were unwound and replaced in their anatomical position. Shortly after the procedure they became pink. Serial ultrasound examinations showed viable, intrauterine fetuses and ovaries with normal blood flow. Laparoscopic ovarian detorsion is a safe and easy procedure, and can be carried out in advanced gestation until approximately 20th week if special safety measures are adhered to.

Adult↗
PubMed1994

The role of intrapartum vibroacoustic stimulation in the prediction of neonatal myasthenia gravis.

BACKGROUND: The exact mechanism for the development of neonatal myasthenia gravis is unclear, and the occurrence of neonatal myasthenia gravis cannot be predicted. CASE: A case of normal duration of fetal forearm extention with return to flexion in response to vibroacoustic stimulation, and the pertinent details concerning neonatal myasthenia gravis and vibroacoustic stimulation test are described. CONCLUSIONS: Inasmuch as fetal acoustic stimulation test results in a fetal reaction resembling the startle response of the newborn, we think that it will worthwhile to perform this test antenatally in the next encountered fetuses of myasthenic mothers in order to assess its role in the prediction of neonatal myasthenia gravis.

Acoustic Stimulation↗
PubMed1994

Early diagnosis and successful nonsurgical treatment of viable combined intrauterine and cervical pregnancy.

Cervical pregnancy is a rare form of EP often resulting in an obstetric catastrophe. We report a case of a combined viable IUP and cervical pregnancy resulting from IVF-ET treatment and which was diagnosed during the 7th week of gestation. Nonsurgical treatment consisting of selective intra-arterial catheterization and administration of MTX directly into the uterine arteries was carried out successfully. Complications were avoided, and the patient's reproductive capability was preserved.

Adult↗
PubMed1994

Laparoscopic management of adnexal cystic masses in postmenopausal women.

OBJECTIVE: To evaluate laparoscopic treatment of postmenopausal women with an adnexal cystic mass predicted to be benign. METHODS: Selection criteria were transvaginal sonographic appearance other than a complex cyst and a normal serum CA 125 level. During the period May 1988 to June 1993, 55 women fulfilled the criteria and underwent operative laparoscopy. During the same period, 75 postmenopausal women underwent exploratory laparotomy for an adnexal cystic mass that was complex in appearance or associated with elevated serum CA 125. RESULTS: Laparoscopic bilateral oophorectomy was performed in all 55 women. All had benign masses (positive predictive value 100%). Malignant tumors were found in 23 of the 75 women undergoing laparotomy (negative predictive value 30.7%). There was no significant difference in size of the tumors between women undergoing laparoscopy or laparotomy. CONCLUSION: Because of its safety and efficacy, laparoscopic management is the preferred procedure in postmenopausal women with a non-complex adnexal mass and a normal CA 125 level.

Adnexal Diseases↗
PubMed1994

Ultrasound controlled operative hysteroscopy.

BACKGROUND: Uterine perforation is one of the risks of operative hysteroscopy. Although usually performed alone, laparoscopy has been recommended to aid the surgeon in preventing uterine perforation at the time of operative hysteroscopy. STUDY DESIGN: Since women suffering from infertility or habitual abortion with known or suspected intrauterine pathologic factors are at low risk for secondary pelvic abnormalities, we have been using ultrasound for control during operative hysteroscopy in these women. One hundred twenty-eight women underwent ultrasound-guided operative hysteroscopy. RESULTS: There were no complications, such as uterine perforation, during or after any of the procedures. CONCLUSIONS: Women with known intrauterine pathologic factors should be offered operative hysteroscopy controlled by ultrasound, avoiding the use of unnecessary laparoscopy.

Female↗