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Biomedical subjects

G Ohel

Publications and source records attributed to G Ohel.

At least 55 records · Page 3Linked to original sources
PubMed1995

Mode of delivery following external cephalic version and induction of labor at term.

External cephalic version should be followed by fetal and maternal surveillance until delivery. To shorten this period of surveillance, a protocol of version at term, followed by immediate induction of labor, was adopted. The aim of the present study was to evaluate the effect of this protocol on the subsequent mode of delivery. Two hundred and ninety-one singleton breech pregnancies were included in this study. Of these, 74 cases underwent version, 75% of which were successful. Success of version compared to failed version was associated with statistically significant (p < 0.001) lower rate of cesarean sections (9% and 67%, respectively). The overall rate of abdominal deliveries in the version group (74 cases) was statistically significantly lower compared with two other groups: one composed of breech pregnancies that did not undergo versions, but would have been qualified for it, had they been referred on time (121 cases), and the other (96 cases) that did not have versions done because of contraindications to its performance (cesarean rates, 23%, 54%, and 79%, respectively; p < 0.001). It may be concluded that a policy of external cephalic version at term is effective in lowering the incidence of cesarean deliveries, and the added intervention of induction of labor does not negate this effect.

Breech Presentation↗
PubMed1995

Pemphigus vulgaris and pregnancy.

Pemphigus vulgaris (PV), an autoimmune bullous dermatosis, is rarely encountered in pregnancy. Two women with PV and their three pregnancies are described. Pregnancy outcome was generally good, although one of the neonates had characteristic PV skin lesions that resolved spontaneously. The pathophysiology, clinical manifestations, and special issues of PV pertaining to pregnancy are discussed. With our cases added, there are now 23 reports in the English literature on PV in pregnancy. From these data it seems that transient skin lesions may occasionally appear in the neonate regardless of the severity of maternal disease. Such lesions are due to passive transplacental transfer of PV antibodies and do not have long-lasting clinical implication. On the other hand, and contrary to past traditional thinking, PV may be associated with poor neonatal outcome including prematurity and fetal death. Such complications seem to be restricted to pregnancies with clinically severe PV.

Adult↗
PubMed1995

Unilateral hematometrocolpos associated with double uterus.

The case of twelve year old girl with double uterus, unilateral vaginal obstruction and ipsilateral renal agenesis is described. Excision of the imperforate vaginal septum resulted in drainage of the hematometrosalpingocolpos and complete disappearance of the large pelvic-abdominal mass. Such a mass in normally menstruating women may detract from the true diagnosis. Awareness of this relatively rare condition is the mainstay of prompt diagnosis which will prevent unnecessary and destructive surgery.

Child↗
PubMed1994

Fetal urine production after induction of labor with prostaglandin E2.

The effect of prostaglandin E2 on fetal urine production was examined in women undergoing labor induction. An effect may be expected, because the administration of indomethacin, a potent antiprostaglandin, has been shown to cause a decrease in fetal urine production and subsequent oligohydramnios. The mean hourly fetal urine production before and 4 hours after vaginal application of prostaglandin E2 were similar (38 and 43 ml per hour, respectively). The application of prostaglandin E2 need not be taken into consideration when fetal urine production is assessed.

Administration, Intravaginal↗
PubMed1994

Epidural anesthesia in early compared with advanced labor.

OBJECTIVES: To examine whether continuous lumbar epidural analgesia administered in the early phase of labor leads to an increased incidence of instrumental vaginal deliveries. METHODS: In a retrospective analysis we have studied 563 consecutive term cephalic vaginal deliveries where an epidural was given for pain relief in labor. The type of delivery was compared in two groups. In Group 1 epidurals were given when the cervix was 3 cm or less dilated; in Group 2 when they were greater than 3 cm dilated. RESULTS: There was no difference in the incidence of instrumental deliveries in the two groups. Other variables including station of the fetal head, premature rupture of membranes, meconium, and administration of pitocin and pethidine did not effect these results. CONCLUSIONS: There is no justification in delaying epidural analgesia in labor when it is clinically indicated.

Anesthesia, Epidural↗
PubMed1994

Effect of maternal immunization with oral poliovirus vaccine on neonatal immunity.

During the summer of 1988, an outbreak of poliomyelitis caused by poliovirus 1 occurred in Israel, during which a national mass immunization campaign with oral poliovirus was undertaken. This prospective study was undertaken to assess the effect of maternal oral poliovirus immunization during the third trimester of pregnancy on neonatal immunity against poliovirus. Cord blood specimens of 88 neonates, born 2 to 7 weeks after maternal immunization, were examined for antipoliovirus antibodies and compared with 100 samples obtained from neonates 7 months before the outbreak. Blood samples were also obtained from the 62 mothers of neonates who had been immunized 2 to 5 weeks before delivery. Sera were tested for neutralizing antibodies to the 3 poliovirus types using a microneutralization technique. The geometric mean titer to poliovirus type 1 was significantly higher in neonates whose mothers were immunized during pregnancy (87.1) than in the offspring of the nonvaccinated group (53.0), P < 0.05. Two to 3 weeks after immunization, geometric mean titers against all 3 poliovirus types were higher in maternal blood than in cord blood whereas 4 to 5 weeks after vaccination a significant difference was found for type 3 only. Although oral poliovirus immunization during pregnancy resulted in higher neonatal antibody titers to poliovirus type 1, the proportion of newborns with titers of < 1:8 to the 3 poliovirus types did not change significantly.

Antibodies, Viral↗
PubMed1994

In utero vaccination.

It is estimated that 4 million children die each year of vaccine-preventable diseases and another 4 million are permanently disabled. Although vaccination is the most cost-effective health method, there is a discrepancy between our level of knowledge and practices applied. Vaccination of pregnant women provides the mother with antibodies that could be transferred across the placenta and provide the neonate with high antibody titers until active immunization is likely to be protective. The ability to provide such passive childhood immunization is beneficial and cost-effective, especially in developing countries where routine childhood immunization is not widely practiced. Further progress depends on the development of more efficient antigens, carrier proteins, and formulations of multiple-antigen vaccines. Further studies should determine the ideal timing for in utero vaccination to provide protective antibodies to the full-term infant and the premature infant. This ideally should be achieved without compromising the protective effect during the first months of life and without causing immune tolerance when given early in pregnancy. The future of in utero vaccination depends on continuing basic research, which should provide improved vaccines and clinical studies that demonstrate the safety and effectiveness of vaccination for both mothers and infants. Liability issues should be addressed and greater awareness of obstetricians, family physicians, and the general public should be achieved.

Bacterial Vaccines↗
PubMed1993

Clavicular fracture of the neonate: can it be predicted before birth?

A retrospective study of 3873 cephalic vaginal births was undertaken to evaluate which factors are associated with clavicular fractures and thereby assess their clinical relevance in antepartum prediction. Fifty-two neonates with a fractured clavicle were identified, an incidence of 1.3%. Neonates with fractures were compared to a control group without fractures. The two groups were matched for age, parity, and mode of delivery. The neonates with fractures were found to be significantly heavier than controls, with mean birthweights of 3.7 kg and 3.2 kg, respectively (p = 0.000). Significantly more newborns in the fracture group weighed more than 4 kg (p = 0.02). A similar trend was noted when birthweights of previous pregnancies were compared (p = 0.03). Fracture cases had a greater incidence of low 1-minute Apgar scores (p = 0.02), and a higher proportion of births following abnormal progress of labor (19% of fracture group and 2.9% of controls; p = 0.001). Despite these statistically significant differences between the groups, it is not possible to predict most cases of fracture before birth, since the majority of fractures occur in cases not identified by any of the studied parameters.

Birth Weight↗
PubMed1993

Response of neonates to vibroacoustic stimulation.

The response to vibroacoustic stimulation was evaluated in 30 healthy full-term newborns and in five newborns with severe neurologic deficits. The stimulus was applied during a period of quite sleep and a subsequent period of quiet sleep served as the control. All 30 healthy newborns reacted by changing from a state of quite sleep to an active sleep state as determined by heart rate acceleration, irregular respiration, and the appearance of limb movements. Heart rate increased by 19.5 +/- 9.7 beats/min (mean +/- SD) for a mean duration of 21.4 +/- 11.9 seconds. The five newborns with severe neurologic deficits did not show any response to vibroacoustic stimulation, and auditory brainstem evoked responses were also absent. We conclude that this technique may be useful as a screening procedure in the evaluation of the neurologic integrity of newborn infants.

Acoustic Stimulation↗
PubMed1992

Sonographic demonstration of endometrial fluid collection following termination of pregnancy.

Intrauterine fluid collections were demonstrated by transvaginal ultrasound in 19 of 21 patients, 4-6 hours after first-trimester termination of pregnancy. Similar but lesser findings were seen 3 days later in some of the cases. Five days postoperatively, the endometrium appeared normal in all patients. Appreciation of the normal sonographic appearance of the uterine cavity following abortion is important for detecting pseudosac of ectopic pregnancy or the possibility of inappropriate curettage of an intrauterine pregnancy.

Abortion, Induced↗
PubMed1992

Continuous ambulatory peritoneal dialysis as the primary approach in the management of severe renal insufficiency in pregnancy.

Pregnancy is an unusual event in patients with chronic renal failure undergoing dialysis. The outcome in these cases is usually poor. We report a pregnancy complicated by severe renal insufficiency that was managed successfully by continuous ambulatory peritoneal dialysis. Dialysis was initiated at 24 weeks' gestation. At 34 weeks, premature labor associated with peritonitis resulted in the spontaneous delivery of a healthy male infant weighing 2400 g. The use of continuous ambulatory peritoneal dialysis during pregnancy offers theoretical advantages compared with hemodialysis. Our case, added to the available limited experience with this new modality, suggests that it may be an appropriate approach in women developing renal disease for the first time during pregnancy.

Adult↗
PubMed1991

Pseudomonoamniotic twins with cord entanglement following genetic funipuncture.

Amniocentesis was performed twice on a twin gestation, and twice there was cell growth failure in one of the twins. Therefore, funipuncture was attempted at 24 weeks. The anatomical relationship and position of the fetuses, placental cord insertion, and membranous septum dictated needle entry into the cord of the lower left fetus through the sac of the upper right fetus and the septum. The procedure was uneventful and the pregnancy was carried to 39 weeks. However, the septum between the twins had been disrupted, creating a pseudomonoamniotic pregnancy. This was noticed only after delivery of the first fetus, when it was found that the two umbilical cords were entangled. We believe that, whenever possible, puncture of the membrane between twins should be avoided. Should puncture be necessary, the possibility of pseudomonoamniotic twins must be considered.

Adult↗
PubMed1989

The 1984 national perinatal census: design, organization and uses for assessing obstetric services in Israel.

A nationwide perinatal census was conducted in Israel, in which medical, social, ethnic and demographic information on all births that took place in Israel within a predefined 3-month period was collected. The present study is the first to include 22,814 births that took place in all the obstetric units in Israel. The perinatal mortality rate decreased from 23.7 in 1964-68 to 13 in 1983-84. The frequency of cesarean section deliveries almost doubled over the last decade, while the use of forceps decreased significantly and the use of vacuum extraction did not change. The rate of low birthweight, however, remained constant over the last two decades. The level of hospital care has been shown to be significantly associated with perinatal mortality. The Israeli Perinatal Census may be used to provide information needed for promoting priority objectives for pregnancy and infant health, such as improving health status, identifying risk factors, increasing public and professional awareness, and improvement in services by protecting mother and fetus.

Adult↗
PubMed1988

Antepartum fetal heart rate characteristics in cases of premature rupture of membranes.

The present retrospective study investigates the effect of premature rupture of membranes on fetal neurocardiac maturation as reflected by the fetal heart rate (FHR) pattern. The FHR tracings of 41 cases involving premature rupture of membranes of at least 48 hours' duration at 24 to 37 weeks' of gestation were studied. Fifty-two cases of normal pregnancy who were matched for gestational age served as controls. The results demonstrate similar baseline FHR and variability in the study and control group. The incidence of FHR accelerations of 15 beats/min was significantly greater in cases of premature rupture of membranes, and their onset was detected at an earlier gestational age. In addition, the mean amplitude of FHR accelerations was significantly greater in the study group compared with the control group. As a result, patients with premature rupture of membranes have a reactive nonstress test at an earlier gestational age than do control patients. These findings support the concept that premature rupture of membranes causes accelerated neurocardiac fetal maturation, as reflected by FHR pattern, possibly by inducing a stressful intrauterine environment.

Female↗