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Isaac Blickstein

Publications and source records attributed to Isaac Blickstein.

At least 55 records · Page 3Linked to original sources
PubMed2004

Difficult delivery of the impacted fetal head during cesarean section: intraoperative disengagement dystocia.

Cesarean section is commonly perceived as a simple and safe alternative to difficult vaginal birth. However, several trends in obstetrical practice may act in concert to cause impaction of the fetal head during the second stage of labor or, more commonly, following failed instrumental delivery. Subsequently, difficult and potentially traumatic disengagement of the deeply wedged head during cesarean section occurs. The maneuvers to disengage the wedged head include pushing (bimanual or by an assistant) the head through the vagina or, alternatively, pulling the infant's feet through the uterine incision. Although both methods may cause serious maternal and neonatal complications, available data seem to favor the pulling method and better outcome seems to depend on adequate uterine relaxation, the patient's position during operation, and special attention to the uterine incision. More data are needed to establish the frequency and extent of intraoperative disengagement dystocia and to determine the management protocol that carries the lowest risk in such circumstances.

Cesarean Section↗
PubMed2004

Triplet pregnancies in women aged 40 or older: a matched control study.

OBJECTIVE: To determine, in triplet pregnancies, if maternal age is associated with adverse outcome in terms of birth weight characteristics. STUDY DESIGN: We analyzed a nationwide cohort of live-born triplets compiled by Matria Healthcare (Marietta, Georgia). We compared all 171 mothers > or = 40 years old with randomly selected and matched-for-parity mothers aged 25-29 and 35-39 years. The main outcome measures were length of gestation and individual and total triplet birth weight. All the subjects had private health insurance. The sample size was adequate to detect 5% differences at a power of 80%. RESULTS: Birth weights for infants A, B and C were significantly higherfor mothers > or = 40 years (P = .016, .01, and .03, respectively); total triplet birth weight was significantly higher as compared with that in the younger controls (P =.01). Gestational ages were similar in the 3 groups. In addition, the frequencies of births at < 28 weeks and of < 1,000 g were reduced by one-third or more in women aged 40 or older as compared to the younger controls (2.3% vs. 6.4% and 4.5% vs. 7.0%, respectively). CONCLUSION: Older mothers of triplets have better outcomes than do their younger counterparts in terms of total triplet birth weight.

Adult↗
PubMed2004

[Trends in multiple births in Israel].

This study examines trends in multiple births in Israel and compares the Jewish and Arab populations. Multiple births increased 150% in the last three decades. Young mothers to multiples were more frequent in the Arab population (eight times and twice the level for age <20 years and 20-24 years, respectively), whereas older mothers of multiples were more frequent in the Jewish population (twice and six times the level for age 40-44 years, and >45 years, respectively). As expected, triplets were more often represented among low birth weight infants. The incidence of multiples was higher in the Jewish population; however, the trend for Jewish triplets seems to decrease as opposed to the increasing trend in the Arab population. The skyrocketing increased incidence of multiple births is explained by the special significance attributed to motherhood in the Israeli society, which is met by the socio-political milieu and the availability of assisted reproductive technologies. Differences in the incidence of multiples between the Arab and Jewish populations are partly explained by the younger age at first delivery of Arab women.

Adult↗
PubMed2003

A novel approach to intertriplet birth weight discordance.

OBJECTIVE: This study was undertaken to evaluate intertriplet birth weight discordance. STUDY DESIGN: Birth weight discordance greater than 25% was evaluated in a cohort of 2804 US live-born triplets. Symmetric and high- and low-skew sets were defined by the rank of the middle triplet between the heavier and the lighter triplets. Frequencies of discordance level and type were analyzed by gestational age, parity, and total triplet birth weight. RESULTS: Discordance of 25.1% to 35% and greater than 35% was found in 19.4% and 9.5% of the triplets analyzed, respectively. Frequencies of greater than 25% discordant sets demonstrated polynomial relationship to gestational age (R (2) = 0.94, P <.001) total triplet birth weight deciles (R (2) = 0.97, P <.001). Frequencies of discordance type are unchanged throughout gestation. CONCLUSION: Birth weight discordance in triplets is frequent and large and implies exhaustion of fetal growth potential despite a uterine environment that appears to perform at maximal effort in these pregnancies.

Birth Weight↗
PubMed2003

Outcome of triplets and high-order multiple pregnancies.

PURPOSE OF REVIEW: To present data related to the outcome of triplets and high-order multiple pregnancies. RECENT FINDINGS: Current frequencies of high-order multiple pregnancies in most developed countries range between 400 and 800% above the rates observed in the late 1970s. Of particular importance is the striking increase in pregnancies in older mothers. These epidemiological trends are the result of modern infertility treatments. The improved outcome of triplets may be attributed to close antenatal and perinatal care, both of which are more likely to be implemented in patients who can afford treatment for infertility. The overall odds of delivering at least one triplet infant weighing less than 1000 g is approximately 10%. The neonatal complications among triplets weighing less than 1500 g at birth are not much different from those among twins or singletons, except for a higher neonatal mortality rate. Despite this, the frequency of cerebral palsy bears a significant exponential relationship to the number of fetuses, and iatrogenic multiple births are clearly implicated in the increased cerebral palsy rate. In the past few years the perinatal mortality rate for triplets has been approximately 110/1000, three-quarters of which represent neonatal deaths. SUMMARY: Available data imply that in order to improve outcomes further, all multiple pregnancies deserve optimal perinatal care, something that is not always obtainable.

Adult↗
PubMed2003

Birthweight discordance in multiple pregnancy.

This paper reviews several aspects of discordant growth in multiple pregnancies. Discordant growth is not a chance event and therefore several patterns can be discerned. About 75% of twins exhibit < 15% discordance (concordant), 20% are 15-25% (mildly) discordant, and about 5% are more than 25% (severely) discordant. Higher frequencies and increased severity are seen among triplets. Five observations regarding discordance became generally accepted: (a) not all discordant pairs are similar; (b) the larger the discordance level the greater is the risk for an adverse outcome; (c) discordant growth does not necessarily represent growth restriction; (d) a discordance level may have a different clinical implication in different gestational ages; and (e) the smaller fetuses in severely discordant pairs are at disproportionate risk for neonatal mortality. Mild discordance may represent a normal variation between sibs whereas severely discordant pairs often exhibit patterns of growth restriction. Not infrequently, discordance may represent an adaptation to the limited intrauterine space in order to increase gestational age.

Birth Weight↗
PubMed2003

The influence of a male twin on birthweight of its female co-twin - a population-based study.

Fetal growth is influenced by various determinants, with males being heavier than females. It was recently suggested that female birthweight tends to be increased by the presence of a male co-twin. We evaluated this hypothesis in the Israeli population. We reviewed a retrospective population database of the 1993-1998 Israeli Birth Registry. We compared male birthweight in the male-male and male-female combination sets and female birthweight in the female-female and male-female combination sets. We compared the mean birthweight of males and females in three groups of total twin birthweight. The sample of 12,686 sets included 50.6% males. The male-male combination was found in 31.3% sets, female-female in 38.7% and unlike-sex combination in 30.0%. A total twin birthweight of less than 3000g was found in 7.2% sets, of 3001-5000g in 50.7% sets, and of over 5000g in 42.1% sets. The mean male birthweight was 2398 +/- 602 g and the mean female birthweight was 2316 +/- 566g, p <.0001 (95% CI of 67, 96). The mean birthweight of males in the male-male combination was significantly lower than in the unlike-sex combination, p <.0001, in total birthweights over 3000g. No significant difference was found between the mean birthweight of females in the female-female and in the unlike-sex combinations in all total birthweight strata. Our findings do not substantiate a male-related inter-twin influence on female birthweight. Population differences might underlie the opposing observations in the literature.

Birth Weight↗
PubMed2003

Effect of maternal height on gestational age and birth weight in nulliparous mothers of triplets with a normal pregravid body mass index.

OBJECTIVE: To study the effect of maternal height on gestational age and birth weight of triplets born to nulliparous women with a normal pregravid body mass index (BMI). STUDY DESIGN: A 1988-2000 prospective cohort of 1,219 U.S. live-born triplets was evaluated. Patients were grouped into stature categories of 5-cm intervals. Mean values for BMI, height, maternal age, gestational age at birth, total triplet birth weight and frequencies of births at < 28 weeks and with very low birth weight were calculated for each height category. RESULTS: Maternal heights were normally distributed (mean, 165.2 +/- 6.2 cm). We found a significant positive correlation (R2 = .95), different from a zero slope (P < .01), between mean total triplet birth weight and height category. Nulliparous women who were taller than 165 cm had age, BMI and gestational age characteristics similar to those of their shorter counterparts but delivered significantly heavier triplets and were at significantly lower risk of delivering very-low-birth-weight triplets. CONCLUSION: Taller women are more likely to deliver heavier triplets and are at lower risk of delivering very-low-birth-weight triplets. This information should be included in counseling women with the potential of conceiving triplets.

Adult↗
PubMed2003

Intertwin birth weight discordance as a potential adaptive measure to promote gestational age.

OBJECTIVE: To determine if discordant twins are delivered at a more advanced gestational age than concordant twins of the same total twin birth weight. STUDY DESIGN: We used the U.S. National Center for Health Statistics matched multiple birth data file containing all twin births in the United States from 1995 through 1997. Birth weight discordance was defined as > 25% difference between the heavier and lighter twin. We compared mean gestational age between concordant and discordant pairs at 250-g total birth weight intervals in the entire population and in the subgroups of primiparas and multiparas. RESULTS: The frequency of discordant pairs declined with increasing total twin birth weight, from 7.2% at 3,000-3,250 g, to 3% at 4,750-5,000 g (R2 = .94, P < .05), with no significant difference between primiparas and multiparas (all P values > .05). The mean gestational age of discordant pairs was significantly higher across the entire range of total birth weight intervals except for the uppermost interval (> 4,750 g). The effect of discordance on gestational age was modified by parity, with significant differences between concordant and discordant pairs among primiparas mainly at the lower birth weight strata (P < .05). CONCLUSION: In the total twin birth weight range of 3,000-5,000 g, birth weight discordant twins are delivered at a more advanced gestational age than concordant twins. Discordant growth may serve as an adaptive measure to promote maturity by reducing the inevitable uterine overdistension.

Adult↗
PubMed2003

[Autoimmune hepatitis during pregnancy].

BACKGROUND: Autoimmune hepatitis is a rare chronic disease that mainly affects young women and may influence fertility and pregnancy in these patients. OBJECTIVES: To describe pregnancy and labor in a patient suffering from autoimmune hepatitis and to review the relevant literature. METHODS: Computerized literature research. RESULTS: The disease of 9 years' duration did not relapse during pregnancy under continuous treatment with steroids, cytotoxic drugs, ursodeoxycholic acid and vitamins. Pregnancy was uneventful and ended with preterm vaginal delivery at 35 weeks, of a 2299 gram healthy neonate. The patient did well during the postpartum period and 6 months thereafter. Since there is no single diagnostic test for the disease, the diagnosis is based on the combination of clinical, laboratory, and histopathological findings and by exclusion of other causes of hepatitis. CONCLUSIONS: There is paucity of data in the literature on pregnancy in these patients but the treatment protocols seem to be effective for the mother and safe for the fetus. Maternal and fetal complications rates appear to be currently lower than in the past. Given that relapse cannot be predicted, close surveillance during pregnancy is warranted.

Adult↗
PubMed2003

Iatrogenic multiple pregnancies. Do they complicate perinatal care?

This review addresses questions related to medicosocial concerns surrounding the care of women with multiple births and their infants. Relevant articles and texts on twin and triplet pregnancies were reviewed. Population-based data were selected for inclusion whenever possible. Relevant tables were simplified from original sources. The review clarifies obstetric and perinatal questions in a manner that is helpful to clinicians and their patients.

Female↗
PubMed2002

Iatrogenic multiple pregnancy.

Iatrogenic - physician-made - multiple pregnancies (IMPs) significantly contribute to the epidemic of twins and high-order multiples in most developed and in many developing countries. The primary etiology for IMPs is treatment of reduced fecundity, some but not all of which is associated with specific lifestyle changes of women in the second half of the 20th century. IMPs contribute to increased perinatal morbidity and mortality related to prematurity and low birth weights. In addition, the use of assisted conception techniques increases the frequency of monozygotic twinning and related pathology. Because assisted conceptions are costly interventions, current numbers of IMPs represent a balance between the need to maximize success rates and the desire to minimize the untoward outcome rates. We believe that eliminating procedures associated with unavoidable IMPs and controlling the number of transferred embryos can achieve a significant reduction in the adverse perinatal outcomes and costs associated with IMPs.

Adult↗
PubMed2002

Normal and abnormal growth of multiples.

Growth curves of twins and triplets do not support a growth restriction patterns seen in singletons. At the same time that individual members of a twin or a triplet set may be smaller than singletons of the same gestational age, only a minority are indeed SGA by singleton standards. When comparing the entire 'fetal mass' of a multiple pregnancy to that of singletons, multiple gestations are in fact growth promoted, and their individual smaller size are better described as growth adaptation. Data from large twin and triplet series suggest that significant birth weight discordance result from the inability of the uterine milieu to equally nurture twins. In order to promote maturity - gestational age - mild compensation in the form of size discordance begins after mid-gestation. When the uterine environment competently nurtures multiples, total birth weight increases and discordance decreases. Failed adaptation, however, may result in significant growth discordance and restriction.

Adaptation, Physiological↗