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Biomedical subjects

G Ohel

Publications and source records attributed to G Ohel.

At least 73 records · Page 4Linked to original sources

Advanced ultrasonic placental maturation in twin pregnancies.

The mean length of twin pregnancies is shorter than that of singleton pregnancies. The possibility that the shorter gestation of twins is associated with advanced fetal maturational changes was studied in relation to placental maturation. For this purpose, the sonographically determined placental gradings of 158 twin pregnancies and 474 singleton pregnancies were compared at different gestational ages. The percent distributions of placental grades, from I to III, were significantly different throughout the third trimester, with a preponderance of Grade III placentas in the twin group (p less than 0.001). Considering the reported association of Grade III placentas with advanced gestation as well as fetal lung maturity, the present study suggests earlier maturational changes in twin fetuses compared with singleton fetuses.

Female↗

Neonatal auditory acuity following in utero vibratory acoustic stimulation.

The fetal heart rate response to externally applied vibratory acoustic stimulation is currently being evaluated as a test of fetal well-being. We have examined the safety of this procedure by subsequent testing of the auditory nerve and brain stem evoked responses in the neonates. The results demonstrated no differences in auditory acuity when control infants were compared with infants previously exposed to antenatal vibratory acoustic stimulation.

Acoustic Stimulation↗

Alterations of pathological fetal heart rate patterns in labor following vibroacoustic stimulation.

Vibroacoustic stimulation of the fetus in labor was previously shown to result in a transient fetal heart rate (FHR) tachycardia followed by a return to prestimulation FHR pattern. We presently report 3 cases in which FHR patterns of repeat decelerations were changed to normal following vibroacoustic stimulation. These changes may be related to the strong fetal movements evoked by the stimulation and removal thereby of a mechanical problem such as cord compression.

Adult↗

Ultrasonographical evaluation of the incidence of simultaneous and independent movements in twin fetuses.

Fetal movements (FM) may be spontaneous, originating in the fetus itself, or evoked by external stimuli. The relative rate of spontaneous and evoked FM has not yet been documented. As it is impossible to differentiate in a singleton pregnancy between these types of movements - the natural model of twin pregnancy was used. The FM of 10 normal twin pregnancies between 33 and 39 weeks of gestation were studied by two realtime ultrasounds, and were operated by two ultrasonographers over a period of 10 min. The mean number of independent FM of each fetus which occurred while the other fetus was resting was 7.9 FM and 7.7 FM, respectively (average 7.8 FM). A mean of 2.5 FM occurred simultaneously. The rate of independent FM was 75.7% and that of simultaneous FM was 24.3%. Vibroacoustic stimulation applied to the maternal abdomen evoked simultaneous movements of both fetuses in all cases. It is suggested that the independent FM may represent spontaneous FM and that the simultaneous FM may indicate the presence of an external stimuli and are therefore evoked responses.

Female↗

Fetal activity in pregnancies complicated by systemic lupus erythematosus.

Fetal movements were assessed in 7 cases of systemic lupus erythematosus (SLE). The daily fetal movement count was lower than normal in 4 cases. Three patients with renal disease and raised blood pressure had decreased fetal movements until cessation and poor fetal outcome. Uncomplicated cases of SLE did not manifest cessation of fetal movement, and their fetal outcome was favorable. When a decrease in fetal movements becomes apparent and the condition is verified by other biophysical tests, the patient should be delivered provided the fetus is viable.

Female↗

Second primary genital malignancies associated with endometrial cancer.

Epidemiological data on Israeli patients with second primary genital malignancies associated with endometrial cancer is presented. During the 7 years of study, 29 (2.9%) of 1,007 patients with endometrial cancer had additional primary malignancy involving the genital organs. Of these, there were 25 (2.5%) ovarian and 4 (0.4%) cervical malignancies. The occurrence of a second malignancy was related to ethnic origin. The ratio of European/American to Asian/African Jewish descendants was 8.7 to 1. A significantly greater than expected incidence of ovarian and cervical malignancy was detected in the endometrial cancer patient (P less than 0.0001). The prognosis was mainly influenced by the clinical staging of disease at the time of diagnosis. Recognition of the fact that second primary cancers occur at a higher than expected frequency in patients with endometrial cancer, offers an opportunity for their early detection.

Age Factors↗

Fetal response to vibratory acoustic stimulation in periods of low heart rate reactivity and low activity.

The fetal response to vibratory acoustic stimulation during periods of low fetal activity and low fetal heart rate reactivity was studied in 10 healthy pregnant women at term. In each case, two periods of low reactivity were studied. Consecutive cases alternated: The vibratory acoustic stimulus was applied 10 minutes after the first nonreactive period in half of the cases; the remainder were stimulated during the second nonreactive period. The unstimulated period served as a control. After vibratory acoustic stimulation the baseline fetal heart rate, the mean number of fetal heart rate accelerations, and, the number of fetal movements were significantly increased with values in the control nonstimulated periods (p less than 0.0001). This consistent response to vibratory acoustic stimulation may prove to be clinically useful in altering periods of low reactivity observed during nonstress testing of normal fetuses.

Acoustic Stimulation↗

L-deamino-8-d-arginine vasopressin treatment in pregnancy and neonatal outcome. A report of three cases.

Three women with neurohypophyseal diabetes insipidus, treated for prolonged periods, including pregnancy, with L-deamino-8-d-arginine vasopressin, gave birth in our hospital. Two of the infants had severe congenital heart disease, one of which was associated with trisomy 21. The third baby, born prematurely, presented with mild intrauterine growth retardation; at the age of 21 months, the boy had severe failure to thrive, hypotonia, and motor retardation. These three cases raise doubts as to the safety of diabetes insipidus or its treatment in pregnancy.

Abnormalities, Drug-Induced↗

Fetal activity in premature rupture of membranes.

Fetal movement (FM) counts by mothers with premature rupture of membranes (PROM) may be helpful in estimating fetal well being, provided FM assessment is not altered by the reduced amniotic fluid. It is possible that the decreased uterine volume restricts fetal movements, though the closer contact of the fetus to the uterine wall may enhance maternal perception of even weak FM. The present study compared maternally perceived FM in 41 cases of PROM to 120 uncomplicated pregnancies. No significant differences in FM counts were detected between the two groups at any of the gestational ages. Fetal movement counts by mothers with PROM, therefore, can assist fetal surveillance as is the case in pregnancies with intact membranes.

Female↗

Anencephaly and the nature of fetal response to vibroacoustic stimulation.

The fetal response to vibroacoustic stimulation has been used in recent years as a measure of well being. Vibroacoustic stimulation theoretically may evoke both tactile and auditory responses in the fetus. In clinical practice, it is important to distinguish which type of response is actually activated. An answer may be suggested through observation of two anencephalic fetuses who demonstrated no response to such stimulation. Neuroanatomic considerations are discussed that suggest which auditory mechanisms are involved in the fetal response to vibroacoustic stimulation.

Acoustic Stimulation↗

An unusual case of rhesus isoimmunization.

A case of rhesus isoimmunization with spontaneous improvement in severity of erythroblastosis with advancing parity is presented. The isoimmunized pregnant woman after having 3 perinatal deaths all due to severe hydrops fetalis, subsequently delivered 2 Rh-positive surviving infants. In her last pregnancy, the timing of delivery was indicated by cessation of fetal movements, followed by a sinusoidal fetal heart rate pattern. The newborn, needing 5 exchanging blood transfusions, subsequently did well.

Adult↗

Intrapartum vibroacoustic stimulation in cases of normal and abnormal fetal heart rate patterns.

The fetal heart rate (FHR) response to a vibroacoustic stimulation was studied in 100 women during active labor. Three types of FHR responses were noted: acceleration, tachycardia of duration longer than 2 min, and combined acceleration-deceleration response. The last type was significantly more common in labors with abnormal FHR tracings. All fetuses demonstrating FHR response to the stimulation, including those with abnormal FHR tracings, had good outcome. The vibroacoustic stimulation is easily performed, noninvasive, and has no contraindications. Its possible application as an intrapartum test of fetal well-being awaits further clinical confirmation.

Acoustic Stimulation↗

Incidence of spontaneous and evoked fetal movements.

Fetal activity is composed of fetal movements (FM), which are either nonreflexive, originating in the fetus itself, or evoked reflexive FM which are stimulated by the fetal environment. The relative ratio of the spontaneous to evoked FM has not yet been documented. Since it is impossible to differentiate in a singleton pregnancy between these two types of FM on the basis of maternal perception alone, the natural model of twin pregnancy was used. It has previously been shown that the number of FM in a singleton pregnancy is similar to that of each individual fetus in a twin pregnancy of the same gestational age. It was assumed that the factors which cause spontaneous and evoked FM are similar in singleton and twin pregnancies. The fetal activity in 44 twin and 76 singleton pregnancies between 28 and 39 weeks of gestation was assessed during 20 min of nonstress test recording. The means of FM in twins were significantly higher than those in singleton pregnancies. The rate of the spontaneous FM was calculated to be 50-59% of all FM in singleton pregnancies and that of the evoked FM 41-50%.

Female↗

Fetal activity in pregnancies complicated by rheumatic heart disease.

Severe cardiac disease in pregnancy may be complicated by reduced placental perfusion and subsequent fetal deprivation. In the present study we have evaluated one fetal parameter that may thus be affected, namely fetal activity. The study group included patients with rheumatic heart disease: 36 women with mild and 5 with severe disease. Each counted fetal movements 3 times a day and from this the daily fetal movement recording was calculated. One hundred and twenty women with normal pregnancies were the controls. The mild cases had fetal activity which was similar to that of the controls. The severe cases had reduced fetal activity, which was significant statistically at 29 to 32 weeks of gestation. Three in the severe disease group had marked decrease of fetal movements on admission to hospital. A return to normal fetal activity was observed following improvement of the maternal cardiac state. As was previously suggested for other high and low risk pregnancies, the maternal perception and counting of fetal movements may aid the fetal surveillance of patients with rheumatic heart disease.

Female↗

Fetal heart rate accelerations and fetal movements in twin pregnancies.

The rate of fetal heart rate accelerations associated with fetal movements to total fetal movements of twin pregnancies was found to be significantly lower than that of pregnancies with singleton infants. The number of fetal heart rate accelerations was similar. As fetal heart rate accelerations are reflective of fetal movements, the results indicate increased fetal activity in twins that is related to an additive effect of two normally active fetuses.

Female↗

Second primary malignancy in endometrial carcinoma patients.

An epidemiologic study of multiple primary malignant neoplasms in endometrial cancer patients in Israel is presented. During the 7-year period of the study, 104 patients (10.3%) out of 1007 patients diagnosed as having endometrial cancer had another primary cancer. There was a significant difference in the incidence of multiple primary cancers between various ethnic groups, women of European/American origin having higher incidence than women of Asian/African origin. A significantly higher than expected incidence of second primary cancers occurred at the following sites: breast (relative risk, 4.1), ovary (relative risk, 11.6), cervix (relative risk, 5.1), and colon (relative risk, 5.9). The prognosis was mainly influenced by the site of the second primary cancer. The increased incidence of multiple primary malignancies justifies a high level of alertness to the possibility of second primary cancer in endometrial cancer patients.

Adult↗

Fetal movements in hypertensive pregnancies.

The maternally perceived fetal movements counts of 273 hypertensive patients were compared to normal controls and their degree of fetal activity was related to perinatal outcome. Pregnancy induced hypertension was associated with fetal activity which was significantly lower than controls at the beginning of the third trimester and significantly higher at term. In cases of chronic hypertension patients, 8 had cessation or marked reduction of fetal movements to less than 4 in 12 hours, and all had poor fetal outcome. The remaining 265 hypertensive patients had a 92% incidence of good fetal outcome. Markedly reduced fetal movements in hypertensive patients are highly suggestive of fetal distress and following verification by additional tests the appropriate clinical measures should be undertaken.

Female↗