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Biomedical subjects

E Shalev

Publications and source records attributed to E Shalev.

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

Subclinical rubella reinfection during pregnancy followed by transmission of virus to the fetus.

We report a documented case of rubella reinfection during pregnancy in a previously vaccinated woman with residual antibody titre to rubella of 15 IU/ml. The reinfection occurred following an exposure to rubella virus (contact with 6-year-old daughter with clinical rubella) between the 7th and 10th week of pregnancy which resulted in transmission of the virus to the fetus. Umbilical cord blood drawn by cordocentesis was found to be strongly positive for rubella IgM antibody. After termination of the pregnancy rubella virus was isolated in cell culture from fetal tissues.

Adult↗
PubMed1997

Early sonographic diagnosis of Jarcho-Levin syndrome: a prospective screening program in one family.

The purpose of this study was to evaluate the possibility of early diagnosis of Jarcho-Levin syndrome by ultrasound examination of the fetus. Over a period of 5 years, nine women from one Arab family, known to carry an autosomal recessive form of the disease, were prospectively and repeatedly examined using ultrasound. Out of eight pregnancies, four fetuses were diagnosed as being affected by the disease as early as 12 gestational weeks. Three elected to terminate the pregnancy before viability and one was born at term. There were no misdiagnoses. We conclude that early prenatal ultrasonographic diagnosis of Jarcho-Levin syndrome is feasible, although later sonographic confirmation is often warranted.

Abnormalities, Multiple↗
PubMed1997

Essential thrombocythemia during pregnancy.

Essential thrombocythemia is a myeloproliferative disorder characterized by a persistent increase in the platelet count. The disease occurs more often in late middle age, but reports confirm the possibility of earlier occurrence. When the disease affects women during pregnancy, an adverse pregnancy outcome is possible: abortion, intrauterine fetal death, abruptio placentae, intrauterine growth retardation, and premature delivery. The possibility of thrombosis formation in this disease encouraged many physicians to use various treatments aimed at lowering the platelet count. Treatments used during pregnancy include acetylsalicylic acid, dipyridamole, heparin, and plateletpheresis. This article describes pregnancy outcomes and reviews the suggested treatments.

Adult↗
PubMed1996

Prenatal diagnosis of Rambam-Hasharon syndrome.

Rambam-Hasharon syndrome (RHS) is a newly recognized autosomal recessive inborn error in fucose metabolism. Mental retardation, short stature, coarse facies, and recurrent infections are the main clinical findings. Several fucosilated proteoglycans are deficient in these patients. Leukocyte adhesion deficiency type 2 is associated with lack of the membrane glycoprotein sialyl-Lewisx (CD15s). In the red blood cells (RBCs), lack of the membrane glycoprotein H is manifested as a Bombay (Oh) blood type. Two consecutive pregnancies it risk for RHS were monitored during mid-trimester by cordocentesis. One fetus expressed H substance and her blood phenotype was O Rh+. The second fetus, a female, was 2 weeks smaller than expected by dates and had the Bombay blood type. The placenta of the affected fetus was small and irregular. This is the first prenatal diagnosis of this syndrome and the first case found in a female. The documentation of the syndrome in patients of both sexes and the parental consanguinity support an autosomal recessive inheritance. Two apparent recombinations between fucosyl-transferase 1 (FUT1, the H gene) and fucosyl-transferase 2 (secretor) are suggestive of non-allelic heterogeneity. We believe that the Bombay phenotype in this family is caused by a mutated gene, other than FUT1, which is causing multiple deficiencies of fucosilated proteoglycans.

Abortion, Induced↗
PubMed1996

Late selective termination of fetal abnormalities in twin pregnancies: a multicentre report.

OBJECTIVE: To evaluate the outcome of late selective fetal termination based on combined data from eight tertiary perinatal centres. DESIGN: Israeli law requires institutional committee approval for pregnancy termination. Moreover, after 24 weeks only a district superior committee can approve the termination. A total of 36 bichorionic twin pregnancies who underwent selective fetal termination after 24 complete gestational weeks were identified in eight Israeli centres. RESULTS: In 23 women (63.9%) the indication for selective termination was structural anomaly, and in 13 (36.1%) the indication was chromosomal abnormality. The mean gestational age at the time of diagnosis was 24.1 +/- 1.9 weeks. The termination procedure was performed at a mean gestational age of 25.5 +/- 2.0 weeks (median 25, range 24-33 weeks). There was one case of immediate procedure-related complication (i.e. amnionitis) and the unaffected infant died, which was the only perinatal death in this series. No evidence of coagulopathy was reported. Only five women (13.8%) delivered before 34 completed weeks. The mean gestational age at delivery was 36.9 +/- 2.9 weeks (28-41 weeks), and the mean procedure-to-delivery interval was 11.8 +/- 3.2 weeks (median 13, range 3-17 weeks). CONCLUSIONS: Late (> 24 weeks) selective termination in twin pregnancies is associated with favourable perinatal outcome of the healthy twin. In countries where the law permits late pregnancy termination, the parents should be informed of that possibility.

Adult↗
PubMed1996

Factors associated with withdrawal bleeding after administration of oral dydrogesterone or medroxyprogesterone acetate in women with secondary amenorrhea.

The effectiveness of two treatment regiments in inducing withdrawal bleeding in secondary amenorrhea was compared and correlated with the endometrial thickness and endogenous E2 and progesterone concentrations. A prospective, randomized and double-blind study was designed at the Outpatient Clinic of Reproductive Endocrinology, Central Emek Hospital, Afula, Israel. Seventy-seven premenopausal women with oligomenorrhea or amenorrhea, 48 of whom qualified for the study, underwent a 5-day course of either medroxyprogesterone acetate (MPA) 5 mg b.i.d. or dydrogesterone (DG) 10 mg b.i.d. Endogenous pretreatment values of E2 and progesterone and endometrial thickness (by transvaginal ultrasonography) were correlated with the bleeding response. Withdrawal bleeding occurred in 93% of women taking either MPA or DG. Side effects occurred similarly among the groups. Lipid concentrations were unchanged. Endogenous E2 and progesterone were limited predictive value for withdrawal bleeding. Endometrial thickness as measured by transvaginal sonography correlated significantly with the bleeding response.

Administration, Oral↗
PubMed1996

Delivery of the very low birthweight breech: what is the best way for the baby?

A retrospective analysis was done to determine whether vaginally vs. cesarean section-born breech infants in the very low birthweight range are at increased risk for morbidity and mortality. Eighty-three viable singleton breech infants weighing 700-1,600 g, who were delivered in our medical center during the period 1980 through 1993, were followed for up to 5 years of age. Analysis of data after correction for weight, gestational age and other confounding variables such as antepartum complications revealed that survival rates in the 700-1,000 g group were similar in both routes of delivery. In the 1,001-1,600 g group, survival rate was 60.9% after vaginal delivery, as compared to 100% after cesarean section (P < 0.01). No difference was demonstrated in long-term outcome between the vaginal and cesarean groups, although the population was too small to draw statistical conclusions. Considering the limitation of such a retrospective analysis, our data identified a trend that supports prophylactic cesarean section in cases of pre-term breech infants weighing 1,000-1,600 g.

Adult↗
PubMed1996

[Association of bacterial vaginosis in pregnancy with preterm delivery].

In a prospective study we examined the correlation between bacterial vaginosis (BV) during pregnancy and preterm labor. Direct vaginal smears were obtained during the 15th to 20th gestational weeks, and the subsequent delivery records were evaluated for the occurrence of preterm labor. BV was found in 15% of pregnant women at 15-20 gestational weeks, and in 8% at 27-32 gestational weeks. No correlation was found between BV and preterm labor.

Adult↗
PubMed1995

[Laparoscopic surgery].

Laparoscopy is a common and important technique in gynecology, oncology and general surgery. At first laparoscopy was used only as a diagnostic tool, but today it is also used for operations. We describe our experience with laparoscopies in 1155 patients, 923 of which were operative and 232 for diagnosis. Complications included: herniation (2 cases), subcutaneous hematoma (16), wound infection (6) and serous discharge (2). The laparoscopic technique is highly successful and efficient for both diagnosis and surgery. The complication rate is lower, hospitalization and recovery times shorter, and the cosmetic results are excellent.

Hematoma↗
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

A random single Doppler study of the umbilical artery in the evaluation of pregnancies complicated by diabetes.

To evaluate a random single Doppler study of the systolic to diastolic ratio of the umbilical artery as a predictor of perinatal outcome in diabetic pregnancies, a prospective double-blind study was performed in 92 diabetic pregnant women between 28 and 40 weeks of gestation. Main outcome measures were perinatal outcome: group A, normal outcome; group B, poor outcome. The sensitivity and specificity of the Doppler studies as a predictor of poor perinatal outcome were 39% and 92%, respectively. The positive and negative predictive values were 54% and 86%, respectively. Our results suggest that the systolic to diastolic ratio of the umbilical artery offers no advantage over other well-established tests in the management of diabetic pregnancies.

Blood Flow Velocity↗