Biomedical subjects

Isaac Blickstein

Publications and source records attributed to Isaac Blickstein.

65 records · Page 4Linked to original sources

PubMed2002

Total and individual triplet birth weights as a function of gestational age.

OBJECTIVE: Our purpose was to determine the relationship between gestational age and both the total and individual triplet birth weights. STUDY DESIGN: A 1988-2000 prospective cohort of 3238 live-born triplets in the United States was evaluated. The mean individual (heaviest, middle, and lightest) and total triplet birth weights were correlated with gestational age in nulliparous and multiparous patients. RESULTS: The mean total triplet birth weights significantly correlated with gestational age for both nulliparous women and multiparous women, but the respective regression lines were significantly different (P =.0018). The respective regression lines for individual triplets showed a significant linear correlation (R(2) = 0.996-0.998). Interparity and intraparity differences of the individual triplets' regression lines were also significantly different. CONCLUSIONS: The relationships support a model of two distinct growth periods for triplets: an age- and growth-promoting period until 33 weeks and an age-promoting growth-restricting period thereafter.

Adult↗

PubMed2002

The Northwestern Twin Chorionicity Study: I. Discordant inflammatory findings that are related to chorionicity in presenting versus nonpresenting twins.

OBJECTIVE: The purpose of this study was to evaluate the association between chorionicity and discordant chorioamnionitis and funisitis in twin gestations. STUDY DESIGN: This was a retrospective analysis of 1156 twin placentas with a standardized diagnosis of chorionicity, chorioamnionitis, and funisitis for comparison between presenting and nonpresenting twins with dichorionic-separate, dichorionic-fused, and monochorionic placentas. RESULTS: Frequencies of chorioamnionitis in the nonpresenting twin were significantly lower in dichorionic placentas (odds ratio, 0.4; 95% CI, 0.3, 0.6, in dichorionic-separate placentas; odds ratio, 0.5; 95% CI, 0.3, 0.8, in dichorionic-fused placentas) compared with monochorionic placentas. The frequency of advanced inflammation (ie, chorioamnionitis with funisitis) was significantly lower in the nonpresenting twin than in the presenting twin, but only in dichorionic-separate placentas (odds ratio, 0.2; 95% CI, 0.1, 0.4). CONCLUSION: Dichorionic placentas confer significant protection against the spread of chorioamnionitis from the presenting to the nonpresenting gestational sac. In the more advanced process that involves the umbilical cord, only the subset of separate dichorionic placentas confers this protective effect against the spread of inflammation.

Adult↗

PubMed2002

A randomised comparison of early versus late amniotomy following cervical ripening with a Foley catheter.

OBJECTIVES: Ripening of the cervix with a Foley catheter commonly results in cervical dilatation without contractions. We examined the outcome of labour in women who underwent induction of labour using a Foley catheter, followed by either 1. early amniotomy, or 2. augmentation of labour by oxytocin and late amniotomy. DESIGN: Prospective randomised clinical trial. SETTING: Labour and delivery ward of a university teaching hospital. PARTICIPANTS: Pregnant women > or =38 weeks of a singleton gestation, who had had no prior caesarean section. METHODS: All women underwent cervical ripening using a Foley catheter. Following removal of the catheter, women were randomly assigned to either early (n = 80) or late amniotomy (n = 88). MAIN OUTCOME MEASURES: Comparison of mode of delivery and duration of labour between the two groups. RESULTS: The rate of caesarean section was significantly higher in the early amniotomy group compared with the late amniotomy group (25% vs 7.9%; relative risk 1.74; 95% CI 1.3 - 2.34). The increase in caesarean section rate was due primarily to dystocia (15% vs 3.3%; relative risk 1.8; 95% CI 1.32 - 2.45). When excluding caesarean deliveries, no significant difference was found in duration of labour between the groups (8.3 hours (3.8) vs 7.7 hours (2.9)). CONCLUSIONS: In women who undergo cervical ripening with a Foley catheter, augmentation of labour by oxytocin followed by amniotomy during active labour results in a lower rate of caesarean delivery for dystocia.

Adult↗

PubMed2002

Twinning and birth weight in the Israeli Jewish versus Muslim maternities.

Ethnicity differences account for genetic, environmental, lifestyle, and reproductive variables, influencing the rate of twinning (Nylander, 1981). Frequently, ethnic differences correlate with variable perinatal care leading to differences in outcome. Free access to antenatal care, and to facilities for delivery and neonatal care is available for the entire population in Israel, and therefore differences attributed to levels of medical care are practically negligible. We previously evaluated the overall relationship between ethnicity and outcome in a population-based cohort of mothers of twins (Goldman et al., 2001). However, the overall comparison may have masked some differences that could be present. The purpose of this study was to evaluate whether ethnicity is associated with differences in perinatal outcome in randomly selected, matched-controlled Israeli Jewish and Muslim mothers of twins.

Arabs↗

PubMed2002

Treatment options for the twin-twin transfusion syndrome: a review.

This article reviews the treatment options of the twin-twin transfusion syndrome (TTTS). No single therapy is associated with a uniformly improved outcome for the involved twins and success is primarily related to gestational age and severity at diagnosis. Treatment options for severe cases include digitalization, ligation of the umbilical cord, serial amniocenteses, septostomy, laser occlusion of placental vessels, and selective feticide. These modalities are associated with significant risks of complications, and variable results of fetal morbidity and mortality. Therefore, they should be considered when risks of withholding treatment clearly outweigh those associated with intervention.

Female↗

PubMed2002

The odds of delivering one, two or three extremely low birth weight (< 1000 g) triplet infants: a study of 3288 sets.

The odds of an individual triplet pregnancy to end with neonates weighing < 1000 g (extremely low birth weight [ELBW]) are unknown. We analyzed a nationwide perinatal database collected by Matria Healthcare, Inc. (Marietta, GA) to select from 3288 triplets those weighing 500-1000 g, delivered during the period 1988-2000 in the United States. We counted the number of sets with one, two, and three ELBW neonates and compared the incidence of ELBW infants between the subsets of nulliparas and multiparas. The odds of delivering at least one ELBW infant was significantly higher among nulliparas (1:8) than among multiparas (1:14), Odds Ratio (OR) 1.9, 95% Confidence Interval (CI) 1.9, 2.5. The odds of having at least two ELBW sibs in nulliparas (1:16) is twice higher than in multiparas (1:31), OR 2.0, 95% CI 1.3, 2.9. Nulliparas and multiparas had similar odds of delivering three ELBW infants (1:29 versus 1:40, OR 1.3, 95% CI 0.9, 2.1). Nulliparas are at significantly increased risk of delivering one or two ELBW triplets. This observation is no less than alarming and highlighted by the exceptionally high risk of major neurological deficits reported among ELBW infants.

Adult↗

PubMed2002

Growth discordance and the effect of a male twin on birth weight of its female co-twin: a population-based study.

There is an ongoing controversy whether the presence of a male twin affects the birth weight of its female co-twin, and if affected, whether birth weights of females are lower or higher in the presence of a male co-twin. The purpose of this study was to study this controversy in a large population of 12,639 twin pairs born in Israel between 1993-1998. Comparison of 7566 females in same-sex (FF) pairs with 4900 females in unlike-sex (FM) pairs, adjusted for the lighter and heavier twin in the pair, showed significantly higher birth weights of females in FM pairs. The same trend was found when concordant pairs and discordant pairs (birth weight difference > 25%) were compared separately. No significant difference was found when 7912 males in same-sex (MM) pairs were compared with 4900 males in FM pairs, adjusted for the lighter and heavier sib. Our study supports a definite intrauterine effect of the male twin on birth weight of its female co-twin. This consequence may potentially be associated with fetal programming of adult disease.

Birth Weight↗

PubMedDate not supplied

Motherhood at or beyond the edge of reproductive age.

Motherhood at or beyond the edge of reproductive age is a new aspect of what clinicians previously referred to as pregnancy in the "older gravida." With the implementation of infertility treatment, the boundary between "old" and "young" no longer exists. Currently, three types of old mothers are seen in the physician's office: those who accidentally conceive, those who still have fertilizable oocytes for assisted reproduction, and those conceiving with assisted reproduction after egg donation. In the United States alone, the 2001 rates for births to women aged 35-39, 40-44, and 45-49 years rose 30, 47, and 190% compared with 1990. Specifically, there were about 5,000 births to women > or = 45 years. Generally, the majority of the published studies have been unanimous about the special, and perhaps the super-cautious attitude required for the older mother, an approach that translates to higher rates of peripartum interventions. This is despite the fact that although some complications may occur more frequently in older mothers as a result of accumulated prior diseases, there is no direct evidence that older age per se complicates either gestation or parturition. In contrast, the risks for the fetus-neonate depend on the source of the oocytes and relate to the mode of conception. Also, older age has an advantage of better perinatal outcome of twins and triplets. Despite many unanswered questions, clinicians should exercise an unbiased approach and be prepared for the challenges and potential complications related to patients who are older than those seen in the past. The "unnatural" connotation of a pregnancy at an advanced maternal age should be accepted as a consequence of the combined effect of social changes and medical progress and not as a counter-evolutionary phenomenon.

Adult↗

PubMedDate not supplied

Psychosocial resource depletion of parents of twins after assisted versus spontaneous reproduction.

OBJECTIVE: To examine the effect of mode of conception (spontaneous versus induced) on parenting stress, psychological well-being and marital quality during the transition to parenthood among parents of twins. METHODS: The Parenting Stress Index was assessed in 37 parents of twins conceived by assisted reproductive technologies (ART) and compared to that of 38 controls who conceived spontaneously. RESULTS: First-time parents after assisted reproduction experienced significantly higher levels of parenting stress than parents who conceived spontaneously (89.3 vs 72.8). Primiparas following assisted reproduction score lower on psychological well-being than do controls. The two study groups did not differ in their perception of marital quality. In addition, ART primiparous mothers experience higher levels of parenting stress and lower levels of psychological well-being in comparison to primiparous mothers who conceived spontaneously. CONCLUSIONS: The transition to parenthood following assisted reproduction is demanding for both parents of twins. In particular, first-time mothers may require qualified emotional support to facilitate adjustment to twin parenthood.

Adaptation, Psychological↗

PubMedDate not supplied

The journey from infertility to parenting multiples: a dream come true?

Infertility deeply affects psychosocial aspects of young couples, who often erroneously take fertility for granted. The inevitable transformation from apparently healthy adults into patients can lead to loss of self-esteem, confidence, health, close relationships, security, and hope. Frequently, when emotional and psychological resources are diminished after prolonged infertility, the couple may express their desperate wish for a family in the form of accepting without reservation the risks of a multiple pregnancy, ignoring the undeniable increased morbidity and mortality associated with these gestations. It is unclear why a couple embarking on the journey of infertility treatment may prefer a pregnancy that is tenfold as likely to have a serious adverse outcome. Of the three potential explanations for such an attitude--desperation, denial, and ignorance--only the last one can be solved with patient education and adequate counseling. At the same time, it is unjustified to avoid assisted reproductive technologies because of potential adverse outcome, however necessary it is to acknowledge the risk of multiple births.

Adult↗

PubMedDate not supplied

Does the use of folic acid increase the risk of twinning?

The increased rates of twinning and the increased consumption of folic acid are two parallel processes described in recent years. However, the possible association between an increased incidence of twin pregnancies and periconceptional folic acid supplementation remains controversial. Whereas the data indicating that when folic acid levels are increased to the range required for reducing the incidence of neural tube defects, the data pertaining to the increase in twinning rate are significantly incoherent and are flawed by serious confounders, such as fertility treatments and maternal age. The only plausible theory connecting methyltetrahydrofolate reductase mutation, folic acid, and twinning has not been confirmed. In addition, temporal and dose-effect relationships have not been established. Because of the lack of coherence, questionable plausibility, and no clear dose-effect and temporal relationships, a cause (folic acid supplementation) and effect (increased twinning rate) association cannot be, at present, accepted. Thus, the established policy of peri-conceptional folic acid supplementation to reduce the incidence of neural tube defects should be continued.

Adult↗