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Biomedical subjects

E Sheiner

Publications and source records attributed to E Sheiner.

At least 55 records · Page 3Linked to original sources
PubMed2000

Predictors of recommendation and acceptance of intrapartum epidural analgesia.

UNLABELLED: We conducted this prospective study to characterize the obstetric and sociodemographic variables that predict physicians' recommendations and patients' acceptance of intrapartum epidural analgesia. The study population consisted of 447 consecutive, low-risk parturients in early active labor. Epidural analgesia was recommended to 393 patients (87.9%), however only 164 (41.7%) consented to receive it. A multiple logistic regression analysis demonstrated that the severity of pain, as assessed by the medical staff (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.13, 1.93), low parity (OR = 0.57, 95% CI 0.44, 0.74), and low maternal age (OR = 0.89, 95% CI 0.79, 0.99) were significant factors affecting recommendations of epidural analgesia. In a multivariate analysis, severity of subjective pain (OR = 1.39, 95% CI 1.16, 1.68), low parity (OR = 0.80, 95% CI 0.73, 0.99), high education (OR = 90.09, 95% CI 27.02,257.06), and the patients' being secular compared with religious (OR = 2.14, 95% CI 1.08,4.21) were found to be independent predictors of acceptance of epidural analgesia. There are differences between patients offered and those not offered epidural analgesia and between parturients who accept and those who do not accept this analgesia. IMPLICATIONS: We studied the factors that influence the recommendation of epidural analgesia by obstetricians, as well as its acceptance by the laboring patients at a university hospital in Israel. Epidural analgesia was recommended more often to low parity, younger women exhibiting more pain. Parturients who perceived greater pain were more secular, had low parity, and had a higher level of education were more likely to accept it.

Adult↗
PubMed2000

Determining risk factors for intrapartum fetal death.

OBJECTIVE: To determine the antenatal and intrapartum risk factors for intrapartum fetal death (IPFD). STUDY DESIGN: We analyzed 72,875 singleton deliveries > 500 g between the years 1990 and 1997. In order to find independent factors contributing to IPFD, a multiple logistic regression model was constructed. RESULTS: During the study period there were 64 cases of IPFD. Birth weight was inversely associated with IPFD in the multivariate analysis. Other significant factors in the multivariate analysis were mothers older than 35 years, polyhydramnios, congenital malformations, pathologic presentation, abruptio placentae and cord prolapse. No association was found with maternal diabetes or hypertension. CONCLUSION: IPFD was significantly associated with low birth weight, older maternal age, polyhydramnios, congenital malformations and pathologic presentation. Direct causes were abruptio placentae and cord prolapse. Pregnancies in older women and those complicated by polyhydramnios and pathologic presentation should be carefully evaluated during pregnancy and delivery in order to decrease the incidence of IPFD.

Adult↗
PubMed2000

Prenatal diagnosis of congenital hypophosphatasia in a consanguineous Bedouin couple. A case report.

BACKGROUND: Hypophosphatasia is a rare autosomal recessive metabolic disorder characterized by low serum and tissue alkaline phosphatase activity, increased urinary excretion of phosphoethanolamine and ricketslike changes in the bone. CASE: We present a case of prenatal diagnosis of congenital hypophosphatasia in a consanguineous Bedouin couple. The case was diagnosed at 24.5 weeks of gestation. Sonographic evaluation revealed a fetus with short and deformed bones and a hypoechogenic skull. Based on the sonographic findings and the obstetric history of the couple, hypophosphatasia was diagnosed. The parents opted for pregnancy termination. Feticide was accomplished uneventfully. Laboratory findings confirmed the diagnosis. CONCLUSION: This couple was prone to this metabolic disorder due to their consanguineous marriage and previous affected fetus. Early-first-trimester prenatal diagnosis by first-trimester chorionic villus sampling or second-trimester measuring of alkaline phosphatase activity in the amniotic fluid is required to exclude this lethal disease in subsequent pregnancies.

Abnormalities, Multiple↗
PubMed2000

[Relationship between occupation and clinical characteristics and recommendations to stop working in pregnant women who had previously delivered prematurely and those who had delivered at term].

We examined the relationship between occupation and clinical characteristics during pregnancy and medical recommendations to stop working. Using a case-control design, we compared 58 working women who had preterm births, with 126 who had delivered at term. All women were interviewed postpartum while still in hospital. There were no differences between the groups with regard to physical activity outside the home, weekly work hours, nor duration of work. Only a small proportion had been exposed to unusually difficult working conditions, to hazardous agents or to a very uncomfortable working environment. Women who had had preterm births were advised more often to leave their jobs or modify their working patterns. Multivariate analysis revealed that the physician's decision to recommend cessation of work was influenced primarily by complications during the current pregnancy. It appears that our patients at risk for preterm birth are probably correctly identified, and receive appropriate guidelines as to working patterns. It is possible that a poor obstetric history or previous abortions may paradoxically have a protective effect, as they influence the physician to recommend cessation of work.

Case-Control Studies↗
PubMed1999

[Cervical ectopic pregnancy].

Cervical pregnancy is a rare but serious complication. The most frequent presenting symptom is vaginal bleeding, and is thus common in inevitable abortion. Examination reveals a dilated cervix containing products of conception derived from the emptied uterine cavity. The pathologic criteria are cervical glands opposite the placental site, attachment to and actual invasion of the cervix by the placenta, a portion of the placenta below the posterior reflection, and no fetal parts in the corpus uteri. Treatment ranges from hysterectomy to treatment with chemical agents, mostly methotrexate. We present a case of ectopic, cervical pregnancy with exaggerated placental site in the cervix.

Adult↗
PubMed1999

Maternal factors associated with severity of birth defects.

OBJECTIVE: Due to inbreeding and nutritional factors, the Bedouin Arabs represent a high risk population for birth defects. The severity of birth defects is probably related to the time and extent of interference with embryogenesis. The present study was aimed at identifying factors associated with severity of birth defects, in pregnancies of Bedouin women examined at a third level ultrasound clinic. METHODS: The study population consisted of 295 Bedouin women who attended an ultrasound clinic at the Soroka Medical Center between 1990 and 1996. The case group included 188 women carrying fetuses with severe birth defects, defined as incompatible with life or which significantly interfere with normal living. For those defects the option of pregnancy termination was discussed. The comparison group consisted of 107 women whose fetuses were diagnosed with mild defects. RESULTS: Women carrying fetuses with severe birth defects had more pregnancies and more deliveries than women carrying fetuses with mild defects (P = 0.005, P = 0.04, respectively). The severity of defects was found to be unrelated to maternal age, consanguinity, residence, birth order, previously uncompleted pregnancies and birth defects in the family. CONCLUSIONS: Higher birth order was associated with severity of birth defects detected at the second trimester.

Arabs↗
PubMed1999

Does the station of the fetal head during epidural analgesia affect labor and delivery?

OBJECTIVE: To assess whether the station of the fetal head when lumbar epidural analgesia is administered influences the duration or the mode of delivery in low-risk laboring women. METHODS: We prospectively evaluated 131 consecutive cases of low-risk parturients at term who requested intrapartum epidural analgesia. Obstetric outcome of 65 parturients who underwent epidural analgesia when the fetal head was low in the birth canal was compared to 66 patients whose fetal head station was above the ischial spine. RESULTS: Both groups were similar in their obstetric characteristics. Cervical dilatation when performing the epidural analgesia was similar in both groups. The duration of labor and mode of delivery, as well as percentage of malpositions, were not significantly different in the two groups. CONCLUSIONS: The station of the fetal head while initiating epidural analgesia does not influence the duration of labor or the mode of delivery. Therefore, there is no justification to delay epidural analgesia in labor until the presenting fetal part is engaged.

Adult↗
PubMed1999

Neurofibromatosis in pregnancy. Maternal and perinatal outcome.

OBJECTIVE: The aim of this study was to assess the maternal and perinatal outcome in pregnant patients with neurofibromatosis (NF). STUDY DESIGN: During the period between January 1994 and December 1996 eight women with NF were delivered at the Soroka University Medical Center. Maternal age, parity, gravidy and ethnic origin were matched with a control group that included 65 healthy parturients out of a total of 31,642 deliveries that occurred in our institution during this period. Maternal outcome and perinatal complications were compared between the two groups. RESULTS: The prevalence of NF during the study period was 1:2434 deliveries. The mean gestational age at delivery was significantly lower in the study group as compared to the control group, 36.8+/-3.3 vs. 39.2+/-1.5 weeks, respectively (P=0.029). The rate of intrauterine growth restriction was significantly higher in the study group, (46.2% vs. 8.95%, respectively, P=0.0005), as well as stillbirth rate (23% vs. 1.5%, respectively, P=0.011) and cesarean section rate (38.5% vs. 7.7%, respectively, P=0.01). CONCLUSION: Patients with NF have an increased risk of perinatal complications. Thus, close antenatal observation at high risk tertiary centers is required.

Adult↗
PubMed1999

Early amniotomy -- high risk factor for cesarean section.

OBJECTIVE: To evaluate the effect of early amniotomy on mode of delivery and pregnancy outcome in comparison to a group of patients admitted with premature rupture of membranes at term. STUDY DESIGN: The study population consists of all women (n=338) whose labor was induced by amniotomy, between the years 1988 to 1995. The comparison group were all women (n=1865) who were admitted with premature rupture of membranes during the same period. RESULTS: Cesarean section was significantly higher in the amniotomy group than in the comparison group (162 (47.9%) vs. 348 (18.7%), P<0.001). This significant difference was noted only for those who did not had a previous cesarean section (106 (42.4%) vs. 224 (13.8%), P<0.001). Non progressive labor during the first stage was threefold higher in the amniotomy group than in the control group (30.8% vs. 10.9%, P<0.001). Abnormal fetal heart rate patterns were detected during labor in 52 patients (15.4%) of amniotomy group, as compared to 141 cases (7.6%) in the control group (P<0.001). To assess the independent contribution of early amniotomy to having cesarean section in the present delivery, a multiple logistic model was used. Early amniotomy (odds ratio [OR] 3.07, 95% confidence interval [CI] 2.36-4.01), as well as a previous cesarean section (OR 5.04, 95% CI 3.90-6.52) and high parity (OR 1.07, 95% CI 1.03-1.26) were all found as independent risk factors for cesarean section. CONCLUSIONS: Early amniotomy appears to be associated with an increased risk for cesarean section.

Adult↗
PubMed1999

Accidental intra-arterial injection of propofol.

We report a case of accidental intra-arterial injection of propofol in a 30-year-old woman admitted for curettage. The patient reported pain, which was followed by a hyperaemic area of 6 x 7 cm around the injection site. Later a blanching of the distal part of the hand was noticed, lasting for 3 min. When pain appears during propofol administration, an intra-arterial injection must be excluded.

Adult↗
PubMed1999

Characteristics of parturients who choose to deliver without analgesia.

The purpose of the study was to characterize parturients who prefer to deliver without the use of analgesia. The study population consisted of 446 consecutive low risk laboring women in early active stage of labor. Data were collected prospectively by an obstetrician, using a structured questionnaire. The degree of pain was assessed by using a visual analog scale (VAS). An obstetrician and a midwife together estimated the degree of pain as was exhibited by the parturients, using the same scale. Univariate analysis found women who undertake labor without analgesia to be significantly older, with higher birth order, of Bedouin ethnicity and to be of lower educational level than those taking analgesics during labor. Women who refused analgesia had experienced and apparently expressed lower degrees of pain (mean VAS score = 7.4 and 6.7, respectively) than those who consented to analgesia (mean VAS score = 8.6 and 8.0, respectively; p < 0.001). A multiple logistic regression model found only the severity of pain (odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.51-0.88; p = 0.004), as well as high maternal age (OR = 1.12, 95% CI 1.16-2.04; p = 0.038) to be independent factors affecting the decision not to accept analgesia during labor. In conclusion, parturients refusing analgesia were older and had experienced less pain during labor than women using analgesia.

Adult↗
PubMed1998

A review of randomized clinical trials of antibiotic therapy in preterm premature rupture of the membranes.

Rupture of membranes before 37 completed weeks of gestation, and before the onset of contractions occurs among 2-3% of pregnancies, and in about 30%-40% of women who deliver preterm. It is known as preterm premature rupture of membranes (PPROM) and is associated with maternal and neonatal morbidity. It has been postulated that antibiotic therapy may significantly decrease the complications associated with infection. The aim of the present review is to summarize the available data about the value of antibiotic therapy in PPROM.

Anti-Bacterial Agents↗