Biomedical subjects
Publications and source records attributed to G Barkai.
There is an increasing awareness of the association between Candida albicans chorioamnionitis and preterm labor. We present a case of intrauterine fetal death caused by Candida chorioamnionitis at the 21 weeks gestation in a patient with an intrauterine device (IUD).
Selective fetal reduction was performed in the first trimester of pregnancy in 20 women with multifetal gestations after ovulation induction with human menopausal gonadotropin (hMG). In 10 women (group A) reduction was performed transabdominally, and in 10 women (group B) the transvaginal approach was used. The transvaginal technique achieved penetration of several gestational sacs without withdrawing the needle from the uterus. Fetal termination using either procedure occurred with intrafetal injection of potassium chloride. Six (60%, group A) and eight (80%, group B) patients delivered healthy newborns. One patient (group B) is at 30 weeks' gestation. Four (40%, group A) and one (10%, group B) aborted 1 day to 8 weeks after the procedure (1 septic abortion, each group). Our results suggest that transvaginal fetal reduction offers a better outcome, with minimal complications, to patients referred for selective continuation of pregnancy.
Explore the source record for details and available documents.
The Portex catheter and the silver cannula are two of the most widely used biopsy devices for chorionic villus sampling. In a prospective randomized study we used these two devices alternatively in 168 women. Significantly more trophoblastic tissue was obtained with the silver cannula than with the Portex catheter (p less than 0.05) while significantly more failures to obtain villus tissue were recorded with the Portex cannula (8/84 with the silver cannula vs. 19/84 with the Portex cannula; p less than 0.05). In 27 cases where use of the device met with failure to obtain chorionic villi after three attempts the other instrument was then used in the same patient (combined group). Four pregnancies aborted spontaneously after the procedure (2.4%). Significantly more complications occurred in the 'combined' group (4/27 vs. 4/168, p less than 0.05). A higher yield of trophoblastic tissue is possible with the silver cannula than with the Portex catheter.
Transient thrombocytopenia may occur in infants born to mothers with idiopathic thrombocytopenic purpura, suggesting transplacental passage of the antiplatelet factor. Labor in women with idiopathic thrombocytopenic purpura calls for a special management. Irrespective of the maternal platelet count, we believe that labor should be conducted vaginally but reassessed after a thrombocyte count of fetal scalp blood. Maternal thrombocytopenia, which may indicate a possible risk of coagulopathy, should be treated aggressively and followed up with replacement therapy. Percutaneous umbilical sampling is to be avoided because it carries an immediate risk of fetal and maternal complications. A count of 50,000/mm3, obtained early during the course of labor, may be taken as a threshold indicator for abdominal delivery via cesarean section.
Explore the source record for details and available documents.
The combination of an over-distended uterus caused by a multiple-fetus pregnancy with therapeutic bed-rest may cause mechanical ileus. Iatrogenic triggering of a pathological consequence of events is presented in purpose to highlight the simplicity of its prevention.
Intra-amniotic thyroxine has been used for the induction of fetal lung maturity. The long term effects of this therapy was evaluated in a group of eighteen preschool children, 5 to 6 years of age, whose mothers received intra-amniotic thyroxine during the last trimester of their gestation. Eleven children born during the same time period were selected as controls. The children were all clinically well with no evidence of growth or endocrine abnormalities. Neurological assessment was normal and psychomotor development was in the normal range for our population and did not differ from the control subjects. Intra-amniotic thyroxine administered during the last trimester of gestation did not appear to have any significant long term detrimental effects in the treated patients.
Internal podalic version of the second twin in transverse lie has usually been performed after first rupturing the membranes of the second amniotic sac. In a prospective study on internal podalic version with unruptured amniotic membranes, 11 second-born twins in transverse lie were successfully delivered, with good neonatal outcome and without birth injuries. From our experience, it appears that this modified technique, when used within the presented guidelines, offers a reasonable alternative for the safe delivery of the second twin.
The fluorescence polarization of amniotic fluid, a measure of fetal lung maturity, was determined in 518 amniotic fluid samples obtained by amniocentesis. The subjects were divided into seven clinical groups: premature contractions, premature rupture of the membranes, pregnancy-induced hypertension, diabetes, intrauterine growth retardation, vaginal bleeding, and "other" for gestational-age groups of 30 weeks or less, 31-36 weeks, and 37 or more weeks. The proportion of mature values (fluorescence polarization 0.285 or lower) increased progressively from 12.5% at 27-28 weeks to 100% at 39-40 weeks. In the 31-36-week gestation group, the proportion of mature values in subjects with premature rupture of the membranes (84.6%) was significantly higher than in those with premature contractions (60%), severe pregnancy-induced hypertension (50%), mild pregnancy-induced hypertension (55.2%), diabetes class A (50%), insulin-dependent diabetes (60%), and other (63.5%). The mean +/- SD fluorescence polarization value was significantly lower in premature rupture of the membranes (0.256 +/- 0.030) than in premature contractions (0.274 +/- 0.032), mild and severe pregnancy-induced hypertension (0.280 +/- 0.027 and 0.280 +/- 0.035, respectively), and class A and insulin-dependent diabetes (0.285 +/- 0.018 and 0.277 +/- 0.030, respectively). The severity of pregnancy-induced hypertension and diabetes did not appear to influence either the fluorescence polarization value or the proportion of mature results. With the exception of a marked influence of premature rupture of the membranes, abnormal pregnancy conditions did not appear to have a significant effect on fluorescence polarization of amniotic fluid.
Explore the source record for details and available documents.
Sixty twin deliveries after the thirty-fifth gestational week with vertex-breech and vertex-transverse presentations were managed according to a randomization protocol. Thirty-three parturient women (21 vertex-breech and 12 vertex-transverse presentations) were allocated for vaginal delivery and 27 for cesarean section (18 vertex-breech and nine vertex-transverse). Six pairs of twins in the vaginal delivery group were delivered in a different mode than requested by the protocol (two women underwent cesarean section; in four cases the second twin spontaneously changed to vertex presentation). There were no significant differences between 1- and 5-minute Apgar scores and incidence of neonatal morbidity between the second-born twins in both study groups. Firstborn twins had higher 1-minute Apgar scores than the second-born infants irrespective of route of delivery (p less than 0.05). No case of birth trauma or neonatal death was recorded. Maternal febrile morbidity was significantly higher in the cesarean section group than in the vaginal delivery group (40.7% versus 11.1%, p less than 0.05). These results suggest that in twins with vertex-breech or vertex-transverse presentations after the thirty-fifth week of gestational age the neonatal outcome of the second twin was not significantly influenced by the route of delivery.
Fifty eight gravidas near-term underwent external cephalic version using tocolytic treatment and continuous fetal monitoring by cardiotocograph and real-time ultrasound. No unfavorable maternal or fetal effects were recorded. Fetal heart rates showed a significant decline at 10 and 30 min after the procedure with complete recovery at 1 h after external version, but no pathologic tracing was recorded. No uniform heart rate patterns due to external cephalic version could be found.
Fifty healthy gravidas with uncomplicated singleton pregnancies at a gestational age of 35 to 42 weeks were assigned at random for the performance of either a breast stimulation test or an oxytocin challenge test after a nonreactive nonstress test. A satisfactory contraction stress test was achieved in 21 of 25 women in the breast stimulation test group and in 24 of 25 women in the oxytocin challenge test group (nonsignificant difference). Significant differences were found in the cumulative rate of achieved contraction stress tests: in the breast stimulation test group 17 of 21 after 20 minutes and 21 of 21 at 50 minutes whereas in the oxytocin challenge test group only four of 24 at 20 minutes, eight of 24 at 50 minutes, and 21 of 24 at 150 minutes. The mean duration for the achievement of a contraction stress test was 20.9 +/- 11.5 minutes for the breast stimulation test group and 81.3 +/- 48.4 minutes in the oxytocin challenge test group. Uterine hyperstimulation occurred once in each group. No gravida went into labor within 24 hours. Breast stimulation test is a satisfactory alternative to the oxytocin challenge test, is less time-consuming, and is simpler to perform.
Explore the source record for details and available documents.
406 midtrimester amniotic fluid samples were examined for alpha-fetoprotein (AFP) levels and fetal karyotyping. 44 cases with Down syndrome, 12 with Klinefelter syndrome and 14 with other chromosomal abnormalities were diagnosed. The AFP levels were below the median value for the normal pregnancies in 38 of the 44 Down syndrome-affected fetuses. The mean AFP value was significantly lower (p less than 0.0001) in this group. No such difference was found for fetuses affected by Klinefelter syndrome or other chromosomal aberrations. Almost all of the values for the Down syndrome-affected fetuses were, however, within the normal range, thereby precluding the possibility of using this measurement as an alternative to fetal karyotyping as a screening test for Down syndrome.
Explore the source record for details and available documents.
Explore the source record for details and available documents.