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Biomedical subjects

E Schiff

Publications and source records attributed to E Schiff.

At least 55 records · Page 3Linked to original sources
PubMed1997

Prenatal diagnosis of fetal primary cytomegalovirus infection.

OBJECTIVE: To evaluate the validity of prenatal diagnosis work-up for congenital cytomegalovirus (CMV) in women with primary infection. METHODS: Sixty-three pregnant women with primary cytomegalovirus disease (including two with twin pregnancies), referred to three tertiary perinatal centers over 4 years, underwent evaluation for congenital cytomegalovirus. Fetal diagnosis was made after 21 weeks' gestation by amniocentesis and fetal blood sampling (40 subjects), or amniocentesis only (23 subjects). RESULTS: Twenty-two (35%) pregnancies showed evidence of vertical transmission: 13 of them underwent funipuncture, but only ten (77%) of the 13 showed positive immunoglobulin (Ig)-M results in fetal blood. No cases of positive fetal serum Ig-M with negative amniotic fluid culture or polymerase chain reaction were observed. In nine (41%) of the 22 pregnancies with evidence of vertical transmission, abnormal ultrasonographic findings were recorded. Six (27%) women with evidence of vertical transmission continued their pregnancies and in only one (with prenatal ultrasonographic abnormalities) was an infant born with neurologic sequelae. In 41 (65%) pregnancies, no evidence of vertical transmission was found, and 37 continued to term. Only one newborn from this subgroup subsequently showed mild motor disability during a median of 23 months of follow-up. CONCLUSION: Among pregnant patients with primary CMV infection, analysis of amniotic fluid detected all of the infected fetuses. Thus, this is a reliable tool for counseling pregnant women with primary infection. This may guide the patient as to whether or not pregnancy can be continued with a high level of confidence.

Amniocentesis↗
PubMed1997

Fetomaternal haemorrhage discovered after trauma and treated by fetal intravascular transfusion.

Fetomaternal haemorrhage can occur spontaneously, or after abdominal trauma. We describe a case of fetomaternal haemorrhage diagnosed at 27 weeks gestation after blunt trauma. The Kleihauer-Betke smear on admission and during the first week was positive, ranging between 3% and 5%. Cordocentesis revealed a fetal haemoglobin of 8.8 gm/dl. An intravascular fetal transfusion was performed. The weeks until delivery and the neonatal period were unremarkable. Fetal anaemia can be a serious complication of fetomaternal haemorrhage, however, intravascular fetal transfusion is an effective treatment when this occurs. The Kleihauer-Betke test should be performed in every patient with a history of abdominal trauma during pregnancy.

Adult↗
PubMed1997

Managing residual trophoblastic tissue. Hysteroscopy for directing curettage.

OBJECTIVE: To describe our experience with selective removal of residual intrauterine trophoblastic tissue via hysteroscopy. METHODS: This is a descriptive report. Eighteen patients, 16 postabortion and 2 postpartum, underwent a hysteroscopic procedure for removal of residual trophoblastic tissue causing continuous bleeding. At hysteroscopy, a cutting loop was used as a curette for selective removal of the adherent residual tissue, while interference with the rest of the endometrial surface was avoided. RESULTS: Complete removal of the suspected residual tissue was achieved in all patients. Histology confirmed the curettings as trophoblastic remnants. No complications were reported during or immediately after the procedure. The median operative time was 10 minutes (range, 8-20). In all cases the bleeding stopped shortly after the procedure. In each patient, postoperative ultrasonography revealed a uterine cavity free of residual tissue. Five of the patients underwent second-look hysteroscopy several weeks later, and no signs of further residual tissue were observed. CONCLUSION: Selective curettage of residual trophoblastic tissue directed by hysteroscopy is an easy and short procedure and might be preferable to conventional, nonselective, blind curettage.

Abortion, Incomplete↗
PubMed1997

Intraamniotic prostaglandin F2 alpha for pregnancy termination in the second and early third trimesters of pregnancy.

OBJECTIVE: To examine the effectiveness and safety of intraamniotic prostaglandin F2 alpha (PGF2 alpha) instillation during second- and early third-trimester termination of pregnancy. STUDY DESIGN: The study group consisted of 173 women between 18 and 32 weeks of gestation admitted for termination of pregnancy with a live, singleton fetus. The procedure included intraamniotic instillation of 40 mg PGF2 alpha. In cases of failed induction; after 24 hours an additional procedure (repeated PGF2 alpha injection, oxytocin augmentation or extraovular balloon installation) was performed. RESULTS: The mean induction-to-abortion interval was 27 +/- 17 hours, 26 minutes. The induction-to-abortion interval was not significantly influenced by parity, maternal age, indication for pregnancy termination or gestational age at the time of the procedure. Complications were related to a longer induction-to-abortion interval (35 hours, 41 minutes +/- 26 hours, 15 minutes in complicated cases as compared to 25 hours, 43 minutes +/- 15 hours, 28 minutes, P = .012). However, complications were uncommon. CONCLUSION: Intraamniotic PGF2 alpha instillation was safely used for termination of pregnancy, even at advanced gestational ages. The induction-to-abortion interval is the main factor influencing complications and is important as a catalyst for cases that fail to abort within 24 hours.

Abortion, Therapeutic↗
PubMed1997

Prevalence of antibodies to cytomegalovirus in a parturient population in Israel.

The aim of our study was to assess the serologic immunity to cytomegalovirus (CMV) in a population of pregnant women in Israel. We measured the titers of both IgG and IgM to CMV in 6,126 pregnant women by enzyme immunoassay. Of these, 84.3% were found to be positive for anti-CMV IgG and 15.7% were seronegative, and thus susceptible to primary infection. The total number of women positive for anti-CMV IgM, and hence suspected of being infected with the virus during or shortly before their pregnancy, was 43 (0.7%). An acute infection was therefore diagnosed in 4.35% of IgG seronegative women. A significantly higher CMV seropositivity rate was found in the parturient population as compared to surveys conducted in Israel in the 1970's. The seropositivity rates found in Israel are similar to those reported in Asia and Africa. The rate of serosusceptibility and the risk of primary CMV infection in pregnancy are lower in Israel than in Europe and North America. According to the observed incidence of primary CMV infection in pregnant women, it can be estimated that approximately 280 cases of fetal infection occur in Israel every year, potentially resulting in 56 symptomatic newborns.

Adult↗
PubMed1996

Early graft loss secondary to massive hemorrhagic necrosis following orthotopic liver transplantation. Evidence for cytokine-mediated univisceral Shwartzman reaction.

Massive hemorrhagic necrosis (MHN) of the liver following orthotopic liver transplantation (OLT) occurs infrequently during an otherwise uneventful recovery 1 week after OLT. It is characterized by fever and sudden deterioration of allograft function leading to failure in the absence of vascular thrombosis. The etiology is unknown, although it is usually preceded by some degree of allograft rejection. Between 6 and 8 days after OLT, four patients (out of 150) became febrile, hypotensive, and experienced a rapid rise in transaminases within 48 hr. Two patients had evidence of mild rejection; the other two had moderate to severe acute cellular rejection. All patients were ABO identical, crossmatch negative. Bolus steroids were given followed by OKT3 in the two patients with severe rejection. Although sepsis was suspected, antibiotic therapy did not ameliorate the clinical course. Each patient progressed to MHN with severe centrilobular necrosis and variable portal infiltrate. High levels of interferon-gamma and tumor necrosis factor-alpha occurred prior to the rise in transaminases in each MHN patient (155 +/- 39 pg/ml and 414 +/- 201 pg/ml, respectively) compared with levels in OLT patients with severe rejection (14 +/- 4 pg/ml and 26 +/- 5 pg/ml, respectively, P < 0.05). These data support the concept of a cytokine-mediated inflammatory response leading to a univisceral Shwartzman reaction in the transplanted liver. Early recognition of this syndrome and retransplantation are critical for survival.

Adult↗
PubMed1996

Low-molecular-weight heparin during pregnancy and delivery: preliminary experience with 41 pregnancies.

OBJECTIVE: To describe experience with 41 pregnancies treated with the low-molecular-weight heparin enoxaparin. METHODS: The medical charts of 34 women (a total of 41 pregnancies) treated between January 1992 and March 1995 with the low-molecular-weight heparin enoxaparin were reviewed. Most patients (87.5%) received one daily 40-mg injection. In all cases, treatment was continued throughout labor, delivery, and the immediate postpartum period. RESULTS: Therapy was administered for 5-280 days (median 91). One case of a thromboembolic event was recorded during treatment. No systemic or local side effects were reported. During pregnancy, only one patient had mild vaginal bleeding, which resolved spontaneously while therapy was continued. There was no excessive intrapartum bleeding in any of these patients, whether delivered vaginally or abdominally. During treatment, 19 of the 34 patients underwent 24 surgical procedures, including 13 cesarean deliveries, without excessive bleeding. Epidural anesthesia was used during labor in nine of the patients, with no specific complications. The corrected perinatal mortality rate, (ie, the rate of fetal death after 24 weeks' gestation plus neonatal death, excluding a neonate with multiple anomalies) for those neonates delivered after 24 weeks' gestation was 2.7%. There were no cases of intraventricular hemorrhage in any of the neonates. CONCLUSION: This preliminary series, the largest reported to date, demonstrates the relative safety and efficacy of low-molecular-weight heparin therapy in pregnancy and delivery.

Adult↗
PubMed1996

Outcome of twin pregnancies reduced from triplets compared with nonreduced twin gestations.

OBJECTIVE: To compare the outcome of triplet pregnancies reduced to twins who reached 24 weeks' gestation with the outcome of twin pregnancies managed in the same perinatal department. METHODS: The study group included 43 triplet pregnancies reduced to twins who reached 24 weeks' gestation and were delivered between January 1989 and December 1993. The complications and outcomes of these pregnancies were compared with all 134 bichorionic twin pregnancies delivered during 1993. RESULTS: In general, the outcome of triplet pregnancies reduced to twins was not significantly different from that of twin pregnancies. Both pregnancy-induced hypertension and premature contractions were similar in the two groups. The higher incidence of premature rupture of membranes (PROM) in the reduced cases compared with nonintervention twins (18.6 versus 8.2%) was of borderline significance (relative risk [RR] 2.27, 95% confidence interval [CI] 0.98-5.27). Although premature delivery occurred in 30% of patients in both groups, 20.9% of patients in the reduction group delivered before 35 weeks' gestation, compared with 10.4% in the nonintervention group (RR 2.0, 95% CI 0.93-4.30). The mean gestational age was similar in the two groups, as was the risk of low birth weight and respiratory disorders. Differences in the proportion of patients with PROM, low gestation duration, and very low birth weight, although not quite statistically significant, are probably because of the relatively small numbers and, hence, of low power (50-55%), but may be of clinical importance. CONCLUSION: The outcome of triplet pregnancies reduced to twins did not differ substantially from that of nonreduced twin pregnancies.

Female↗
PubMed1996

The importance of urinary protein excretion during conservative management of severe preeclampsia.

OBJECTIVES: We determined the natural course of urinary protein excretion during conservative management of severe preeclampsia and investigated whether changes in urinary protein excretion can predict maternal or perinatal outcome. STUDY DESIGN: We reviewed the medical charts of 66 women with severe preeclampsia which was managed conservatively before 32 weeks of gestation and who had at least two 24-hour urinary protein determinations 4 or more days apart after admission. RESULTS: Fifty-nine (89%) of 66 women had an increase in proteinuria during conservative management of severe preeclampsia. The median increase in protein excretion after admission was 660 mg/24 hours (range-4580 to 18,960 mg/24 hours). Patients were divided into two groups. The first group (n = 24) had an increase in 24-hour urinary protein excretion of > or = 2 gm; the second group (n = 42) had a 24-hour urinary protein excretion that decreased (n = 7) or increased by < 2 gm (n = 35). There were no cases of eclampsia or stillbirth in either group. The rate of HELLP (hemolysis, elevated liver enzyme levels, low platelet counts) syndrome, abruptio placentae, cesarean delivery because of fetal distress, 5-minute Apgar scores < or = 6, and the admission-to-delivery intervals were all similar in the two groups. CONCLUSIONS: Proteinuria increases in most women with severe preeclampsia managed conservatively. No differences in maternal or fetal outcomes were found between pregnancies with marked increases in proteinuria and those with modest or no increases.

Adult↗
PubMed1996

Maternal and neonatal outcome of 846 term singleton breech deliveries: seven-year experience at a single center.

OBJECTIVE: Our purpose was to evaluate the maternal and neonatal outcome of 846 consecutive term singleton breech deliveries at a single center. STUDY DESIGN: We reviewed the maternal and neonatal charts of all women who delivered singleton breech fetuses between 1984 and 1990 and divided them into two groups: women who fulfilled the criteria for trial of labor (group 1, n = 613) and those who did not meet these criteria and underwent scheduled cesarean section (group 2, n = 233). RESULTS: In group I, 326 women (53.2%) were delivered vaginally. There were no maternal deaths. Febrile morbidity and length of hospitalization were significantly higher in the women who required cesarean section in labor compared with those delivered vaginally. In the total study population there were no stillbirths and eight neonatal deaths, 6 of which had major malformations incompatible with life. The remaining two deaths occurred in group I (0.33% corrected neonatal mortality in group 1). Newborns in Group 1 exhibited a higher rate of trauma with borderline statistical significance (3.0% vs 0.5%, p = 0.052). No significant differences were found in the rates of low Apgar scores, intubation, and intensive care unit admission. CONCLUSION: Although certain short-term outcome variables may appear less favorable in term singleton breech infants delivered vaginally, large randomized studies of short- and long-term outcome should be undertaken because current data are not sufficiently conclusive to warrant routine cesarean section for term breech presentation.

Adult↗
PubMed1996

Is fetal neurologic and physical development accelerated in preeclampsia?

OBJECTIVE: Our objective was to determine whether the Ballard score, a maturity score for neonatal neuromuscular and physical development, is more advanced in preterm infants of preeclamptic women than in controls. STUDY DESIGN: A matched cohort study design was used. One hundred women with strictly defined preeclampsia (new-onset hypertension, proteinuria, and hyperuricemia) were matched for gestational age, race, and gender to 100 normotensive women with preterm delivery. All patients had an assigned antenatal gestational age based on ultrasonography before 24 weeks. The gestational age, based on antenatal ultrasonography and last menstrual period, was compared with the Ballard score given at the time of neonatal physical examination within the first 12 hours after delivery. The difference in gestational age between the Ballard score and antenatal ultrasonography (Ballard score - ultrasonography) was calculated for each patient. Results are expressed as median and range and are compared with a Student t test. RESULTS: The mean gestational age at delivery by antenatal ultrasonography in patients with severe preeclampsia was 32.06 +/- 2.74 and 32.03 +/- 2.70 weeks, respectively. The median difference between scores in patients with severe preeclampsia and normal patient were 1.3 +/- 1.8 and 1.5 +/- 1.6 weeks, respectively (p = 0.41). CONCLUSION: On the basis of criteria defined by the Ballard score, preeclampsia was not associated with accelerated fetal neurologic and physical development.

Adolescent↗
PubMed1996

Dietary consumption and plasma concentrations of vitamin E in pregnancies complicated by preeclampsia.

OBJECTIVE: Vitamin E, a potent antioxidant, has been suggested to play a role in preventing preeclampsia. Our aim was to determine whether consumption and plasma levels of vitamin E are lower in the preeclamptic than in normal women. STUDY DESIGN: A case-control study design was used. We identified 48 women with preeclampsia (late-pregnancy hypertension, proteinuria, and hyperuricemia). Ninety normal women served as the control group. Vitamin E consumption was estimated by use of a previously validated dietary recall questionnaire administered by a single trained research nurse to 42 of the preeclamptic women and all 90 of the control women. Blood was drawn from all women and stored until assayed at -70 degrees C. Plasma vitamin E concentrations were determined by use of high-pressure liquid chromatography. RESULTS: The mean dietary vitamin E consumption was similar for both the preeclamptic and control group (11.74 +/- 9.39 vs 11.34 +/- 7.51 mg/24 hr, p = 0.73). When the analysis also included estimations of vitamin E supplements, the total consumption was found to be higher in those who had preeclampsia than in controls (37.20 +/- 20.54 vs 22.3 +/- 27.24 mg/24 hr, p = 0.003). The mean plasma vitamin E concentration was significantly higher in preeclamptic than in control patients (1.41 +/- 0.39 vs 1.15 +/- 0.32 mg/dl, p < 0.001). Among the preeclamptic patients, those with severe disease associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (n = 11) had the highest plasma vitamin E concentrations. CONCLUSIONS: We found no evidence that low vitamin E consumption is related to the development of preeclampsia. Higher plasma vitamin E concentrations in preeclamptic patients are speculated to represent a response to oxidative stress.

Adult↗
PubMed1996

Pregnancy outcome after early amniotic fluid leakage after transabdominal multifetal reduction.

OBJECTIVE: To assess the importance of amniotic fluid leakage in the early period ( < 14 days) after the fetal reduction procedure. DESIGN: Prospective clinical study. SETTING: Pregnant women who underwent fetal reduction to twins in an academic, tertiary perinatal department. PATIENTS: Sixty triplet and 31 quadruplet pregnancies were identified before the ninth postmenstrual week of gestation. All patients underwent transabdominal multifetal pregnancy reduction was performed within 14 days of the procedure. INTERVENTIONS: Transabdominal multifetal pregnancy reduction from triplets and quadruplets to twins. MAIN OUTCOME MEASURE: Amniotic fluid leakage in the early period after fetal reduction. RESULTS: Early PROM occurred in eight (13.3%) patients from the triplets group and in six (19.3%) patients in the quadruplet group. Three of 60 (5.0%) patients from the triplet group and 1 of 31 (3.2%) patients from the quadruplet group miscarried before 24 weeks gestation. However, none of these patients had had PROM during the early period after the procedure. Early PROM did not influence the incidence of premature contractions of delivery and the reduction procedure, and 59% (99/169) of those who completed 24 gestational weeks delivered between 25 and 37 weeks. CONCLUSION: The presence of amniotic fluid leakage in the period close to the multifetal reduction procedure, although alarming, is not ominous for the remaining fetuses. We see no reason for any intervention in these patients.

Abortion, Spontaneous↗
PubMed1996

Second-trimester serum fluorescence polarization in patients who subsequently develop pregnancy-induced hypertension.

To determine whether the midtrimester serum lipid profile, as expressed by fluorescence polarization (FP) values, is decreased in patients who subsequently develop pregnancy-induced hypertension (PIH). Stored serum samples of normotensive patients who had undergone midtrimester biochemical screening for Down's syndrome were used in this case-control study. Forty patients who subsequently developed PIH comprised the study group, and were divided into subgroups with proteinuric PIH (P-PIH, n = 18) and those with nonproteinuric PIH (NP-PIH, n = 22). Sixty randomly selected patients who remained normotensive throughout pregnancy comprised the control. Serum total cholesterol (CL) and triglycerides (TG) were determined using enzymatic colorimetric kits. FP values were determined by optical microviscosimeter. Both study subgroups had significantly lower FP values and higher TG concentrations than the control group. Total CL concentrations were slightly higher in the P-PIH subgroup. There were no differences in mean. Total CL or TG concentrations or mean FP values were found between those patients who developed mild and severe PIH. Using FP value cutoff points of 0.250, 0.245, and 0.240 sensitivity was 95%, 90%, and 78%, respectively, in detecting patients who subsequently developed PIH. Midtrimester serum FP values may have some predictive value for the development of P- and NP-PIH.

Adult↗