Biomedical subjects

Jacob Bar

Publications and source records attributed to Jacob Bar.

16 recordsLinked to original sources

PubMed2004

Mode of delivery in pregnancies with premature rupture of membranes at or before term following induction of labor with vaginal prostaglandin E2.

Our aim was to evaluate the mode of delivery in pregnancies complicated with premature rupture of the membranes (PROM) at or before term following induction of labor with vaginal application of prostaglandin E2 (PGE2), and to identify possible predictors leading to cesarean section (CS). The study sample consisted of 220 women with term-PROM who did not enter spontaneous labor after 24 hours of expectant management and 42 with preterm (P)-PROM, who underwent labor induction with vaginal PGE2. Findings were compared with 115 women admitted for elective induction of labor, and 510 women with normal spontaneous-onset labor. There were no between-group differences in gravidity, parity, nulliparity rate, or number of PGE2 tablets used. Women with P-PROM were admitted at 34.6 +/- 2.4 weeks gestation, and delivered at 36.1 +/- 1.6 weeks (mean interval, 5.0 +/- 7.9 days; range, 0.5 to 40 days). The rate of CS was different only between the term-PROM (18.6%) and spontaneous onset of labor (9%) groups (odds ratio, 2.08; 95% confidence interval, 1.4 to 3.4). The rate of low 5-minute Apgar score (< 7) was similar in all groups, but the incidence of nonreassuring fetal heart rate pattern leading to CS was significantly lower in the PROM groups. A logistic regression model and forward likelihood analysis in the PROM groups yielded parity, higher number of PGE2 tablets used, and higher birth weight as independent and significant variables associated with increased risk of CS. Using our management protocol, 36.4% and 20.4% of women with term-PROM and P-PROM, respectively, required labor induction with PGE2, which was successful in more than 80% of cases, with no apparent serious maternal or fetal complications.

Administration, Intravaginal↗

PubMed2004

C-reactive protein levels in patients undergoing controlled ovarian hyperstimulation for IVF cycle.

BACKGROUND: The aim of the present study was to determine serum and follicular fluid C-reactive protein (CRP) levels in patients undergoing controlled ovarian hyperstimulation (COH) for IVF-embryo transfer cycle, and their possible correlation to COH variables. PATIENTS AND METHODS: The subjects were 16 consecutive patients undergoing our routine IVF long GnRH agonist protocol. Blood was drawn three times during the COH cycle: (i) the day on which adequate suppression was obtained (Day-S); (ii) the day of, or prior to HCG administration (Day-HCG); and (iii) the day of (and before) oocyte pick-up (Day-OPU). Levels of sex steroids and serum and follicular fluid CRP were compared among the three time points. Serum and follicular fluid CRP were measured with a commercial immunoturbidimetric assay. RESULTS: Serum levels of CRP were significantly higher on Day-OPU and Day-HCG than on Day-S, and significantly higher on Day-OPU than on Day-HCG. No difference was observed between follicular and serum CRP levels on Day-OPU. No significant correlations were found between serum and follicular fluid CRP, or between serum CRP-to-BMI ratio and serum sex steroid levels or IVF treatment variables. CONCLUSIONS: The significant increase in serum CRP levels during COH, especially after HCG administration, suggests that COH potentiates a state of systemic inflammation.

Adult↗

PubMed2004

Pregnancy outcome in women with heart disease undergoing induction of labour.

OBJECTIVE: To examine the safety and outcome of induction of labour in women with heart disease. DESIGN: Prospective single-centre comparative study. SETTING: Major university-based medical centre. POPULATION/SAMPLE: One hundred and twenty-one pregnant women with heart disease. METHODS: The sample included all women with acquired or congenital heart disease who attended our High-Risk Pregnancy Outpatient Clinic from 1995 to 2001. The files were reviewed for baseline data, cardiac and obstetric history, course of pregnancy and induction of labour and outcome of pregnancy. Findings were compared between women who underwent induction of labour and those who did not. Forty-seven healthy women in whom labour was induced for obstetric reasons served as controls. MAIN OUTCOME MEASURES: Pregnancy outcome. RESULTS: Of the 121 women with heart disease, 47 (39%) underwent induction of labour. There was no difference in the caesarean delivery rate after induction of labour between the women with heart disease (21%) and the healthy controls (19%). Although the women with heart disease had a higher rate of maternal and neonatal complications than controls (17%vs 2%, P= 0.015), within the study group, there was no difference in complication rate between the patients who did and did not undergo induction of labour. CONCLUSION: Induction of labour is a relatively safe procedure in women with cardiac disease. It is not associated with a higher rate of caesarean delivery than in healthy women undergoing induction of labour for obstetric indications, or with more maternal and neonatal complications than in women with a milder form of cardiac disease and spontaneous labour.

Adult↗

PubMed2004

Mode of delivery in pregnancies with suspected fetal growth restriction following induction of labor with vaginal prostaglandin E2.

BACKGROUND: Many fetuses below the 10th percentile for gestational age are uncompromised. We aimed to evaluate the mode of delivery and immediate neonatal outcome in pregnancies with suspected fetal growth restriction (FGR) and normal antenatal assessment following induction of labor with vaginal application of prostaglandin E2 (PGE2). METHODS: Ninety women with suspected FGR (sonographic estimated fetal weight < 10th percentile) with normal oxytocin contraction test (OCT), biophysical profile (BPP) and reassuring fetal heart rate underwent induction of labor with vaginal application of PGE2 tablets. The findings were compared with 115 women admitted for induction of labor because of decreased fetal movement (group 2) and with 510 women with normal spontaneous onset of labor (group 3). RESULTS: There were no between-group differences in mean maternal age, gravidity, parity, nulliparity rate, number of tablets used or rate of patients receiving more than one PGE2 application. The rate of cesarean section (CS) in the study group (8.9%) was similar to the rate in groups 2 and 3 (14.8% and 9.0%, respectively). The incidence of nonreassuring fetal heart rate pattern leading to cesarean delivery was higher in the study group, but the rate of low 5-min Apgar scores (< 7) was similar in all groups. A logistic regression model and forward likelihood analysis yielded no single significant variable associated with increased risk of cesarean delivery. CONCLUSIONS: In selected cases of suspected FGR with reassuring fetal heart rate and normal OCT and BPP, induction of labor with vaginal PGE2 may yield a similar immediate fetal outcome and CS rate as in uncomplicated, induced or spontaneous deliveries.

Administration, Intravaginal↗

PubMed2004

Serum P-selectin level during controlled ovarian hyperstimulation--a preliminary report.

OBJECTIVE: To measure levels of serum P-selectin in patients undergoing controlled ovarian hyperstimulation (COH) cycles and to determine their possible correlation to COH variables. SETTING: Large university-based infertility and in vitro fertilization unit. PATIENTS: Fourteen consecutive patients undergoing our routine COH protocol for unexplained infertility. INTERVENTIONS AND MAIN OUTCOME MEASURES: Blood was drawn three times during the COH cycle: (1) day 2 or 3 of the menstrual cycle, before gonadotropin treatment (Day-0); (2) day of or prior to human chorionic gonadotropin (hCG) administration (Day-hCG); and (3) day of ovulation (Day-OVU). Serum levels of sex steroids and P-selectin were compared among the three time points. P-selectin was measured with a commercial quantitative sandwich immunoassay technique. To reduce interpatient variability, the percent difference between the Day-0 (non-stimulated, basal) level and the Day-hCG and Day-OVU levels was calculated. RESULTS: P-selectin level on Day-hCG was significantly higher than on Day-0 (P < 0.05) and non-significantly higher than on Day-OVU (P < 0.12). No significant correlations were observed between serum P-selectin and patient age, amount of gonadotropins used, or estradiol or progesterone level. CONCLUSION: The increase in serum P-selectin level during COH until peak estradiol suggests that COH may potentiate a state of platelet activation which is substantially attenuated after hCG administration.

Adult↗

PubMed2004

Gestational diabetes mellitus--implications of different treatment protocols.

OBJECTIVE: To assess the impact of different management approaches to gestational diabetes mellitus (GDM) on perinatal outcome. PATIENTS AND METHODS: The study group consisted of 2,060 patients with GDM treated in our center from January 1980 through December 1999. Four time periods were defined on the basis of changes in treatment protocols. Perinatal complications were compared between the periods and with normal pregnancy controls. RESULTS: The last two periods (1993-1999) were characterized by lower mean glucose level, lower mean gestational age at delivery, and a decline in macrosomia, shoulder dystocia and perinatal mortality rates, but also by high rates of labor induction and Cesarean delivery. A significant difference was found between the GDM and normal control groups in rates of labor induction (38.6% vs 10.8%, p < 0.001) and Cesarean delivery (34% vs 20%, p < 0.001) for the last period. CONCLUSIONS: Perinatal complications are preventable with good glycemic control and early induction of labor, but at a cost of a higher Cesarean section rate.

Blood Glucose↗

PubMed2004

Indicated labor induction with vaginal prostaglandin E2 increases the risk of cesarean section even in multiparous women with no previous cesarean section.

AIMS: To evaluate the impact of induction of labor with vaginal tablets of prostaglandin E2 on the rate of cesarean section (CS), and to identify possible predictors of successful vaginal delivery. METHODS: 1541 consecutive women admitted for induction of labor with vaginal tablets of PGE2 were retrospectively compared with 574 consecutive women with spontaneous onset of labor. RESULTS: Maternal age, nulliparity, previous CS, gestational age, and birth weight were similar in the study and control groups. The CS rate was twofold higher in the study group (20.7% vs 10.6%). CS rates in the study and control groups were 26.9% and 12.8% for the nulliparous women, and 11.2% and 5.1% for the multiparous women with no previous CS. Neither group had major maternal or fetal complications. A logistic regression model and stepwise analysis showed that nulliparity, previous CS, maternal age, number of PGE2 applications, birth weight, and the induction of labor by itself were independent significant risk factors for increased CS rate. CONCLUSIONS: Induction of labor with vaginal PGE2 tablets results in a vaginal delivery rate of 79.3%, with apparently no serious maternal or fetal complications. Nulliparity, and previous CS are the most significant risk factors for increased CS rate. However, even after these risk factors are excluded and controlling for possible predictors for CS, PGE2 induction is independently associated with a twofold increase in CS rate, most often because of labor dystocia.

Administration, Intravaginal↗

PubMed2003

Is immunosuppression therapy in renal allograft recipients teratogenic? A single-center experience.

The aim of the study was to determine whether immunosuppressive agents used in renal allograft recipients are teratogenic or otherwise associated with pregnancy outcome. The study population consisted of 38 renal allograft recipients treated with combinations of prednisone, azathioprine, cyclosporin A, and tacrolimus attending our Hypertension in Pregnancy Clinic. The 48 live offspring of 73 pregnancies in this group were evaluated for major congenital malformations and mild errors of morphogenesis. Findings were compared with those in 48 offspring of 41 women with primary renal disease not treated with immunosuppressive drugs. Pregnancy outcome parameters were also compared between the study and control groups in the perinatal period and on a long-term basis (2-7 years after birth). Two major anomalies (4.2%), subcoronal hypospadias and rudimentary thumb, and 10 mild errors of morphogenesis (20.8%) were detected in the study group. These rates did not differ significantly from those in the control group (4.2% and 16.6%, respectively). Pregnancy outcome was worse in the renal transplant patients than in the women with primary renal disease in terms of prematurity (60% vs. 21%, P = 0.001), growth restriction (52% vs. 17%, P = 0.001), and hospitalization in a neonatal intensive care unit (35% vs. 6%, P = 0.01). In conclusion, the similar prevalence of major anomalies and mild errors of morphogenesis in offspring of the renal transplant patients and the women with primary renal disease suggests that immunosuppressive therapy is not a teratogenic factor. It may, however, be associated with worse pregnancy outcome.

Abnormalities, Drug-Induced↗

PubMed2003

Interleukin-2 production in whole blood cell cultures of women undergoing controlled ovarian hyperstimulation for assisted reproduction technology cycles.

PROBLEM: To determine whether human chorionic gonadotropin (hCG) modulates the in vitro release of interleukin (IL-2) from human peripheral lymphocytes and monocytes derived from patients undergoing controlled ovarian hyperstimulation (COH). METHOD OF STUDY: A large university-based IVF unit was used for the study. Blood was drawn thrice from 12 women undergoing our routine IVF long gonadotropin-releasing-hormone-analog protocol during the COH cycle: (1) day on which adequate suppression was obtained (Day-S); (2) day of or prior to hCG administration (Day-hCG); and (3) day of ovum pick-up (Day-OPU). At each point of time, blood was tested for sex-steroid levels and then cultured for 72 hr either without (control-culture) or with hCG (hCG-culture) or with mitogenic stimulation by phytohemagglutinin (PHA-culture). The culture-medium supernatants were tested for IL-2 levels with a commercial sandwich enzyme-linked immunoassay. RESULTS: Whole blood culture IL-2 levels increased significantly during COH until peak E2, and then decreased significantly after hCG administration. IL-2 levels were decreased in the control- and PHA-culture media on Day-OPU compared with Day-hCG. There were no significant correlations between IL-2 levels in the culture media and serum estradiol, progesterone or human chorionic gonadotropin levels. CONCLUSION: Apparently, hCG attenuates IL-2 production by mononuclear cells with and without mitogenic stimulation, irrespective of the estradiol level. This suggests that hCG may indirectly modulate the inflammatory response, resulting in the ovarian hyperstimulation syndrome.

Adult↗

PubMed2003

Pregnancy outcome in women treated with doxorubicin for childhood cancer.

OBJECTIVE: Pregnancy outcome and the effect of pregnancy on cardiac function were assessed in women cured of childhood cancer. STUDY DESIGN: Forty women who received doxorubicin as part of a chemotherapy protocol for a neoplastic disorder in childhood were followed up at the same center during pregnancy and after delivery. RESULTS: Thirty-seven women (72 pregnancies) completed follow-up. Pregnancy outcome was favorable in the 29 women with fractional shortening values of >or=30% before pregnancy, and their myocardial function was sustained. In 8 women with fractional shortening of <30% before pregnancy, pregnancy outcome was less favorable; a 19% decrease in fractional shortening was observed after pregnancy, and this finding was not significant (P=.08). CONCLUSION: Pregnancy outcome in women who received doxorubicin for malignancy in childhood is generally favorable. However, those with baseline left ventricular dysfunction should be considered at increased risk for worse pregnancy outcome and further deterioration in myocardial function.

Adolescent↗

PubMed2003

Surface expression of neutrophil adhesion molecules in pregnant women at risk for hypertensive complications.

OBJECTIVE: To determine if neutrophil activation is a pathogenetic factor in hypertensive disorders in pregnancy, the neutrophil expression of adhesion molecules was prospectively investigated in pregnant women at risk, prior to the development of hypertensive complications. METHODS: Two neutrophil activation parameters, beta2-integrin (CD11b) and l-selectin (CD62L), were assessed at admission between 14 and 24 weeks of gestation in 82 pregnant women at risk of preeclampsia and other hypertensive complications. Results were compared to those in 20 healthy normotensive women. RESULTS: Of the 82 women at risk, 23 (28%) developed hypertensive complications: 9 (11%) preeclampsia and 14 (17%) others, such as intrauterine growth restriction (n = 6), fetal or neonatal loss (n = 8), and preterm delivery (< or = 30 weeks of gestation) (n = 8). All pregnancy outcome measures were significantly worse in the patients with complications than in those at risk but without complications or the healthy controls. Expression of beta2-integrin was significantly higher in early stages of pregnancy in the women who eventually developed complications than the women who did not, P =.019, or the healthy controls, P =.049. CONCLUSIONS: Surface expression of beta2-integrin is increased in pregnant women at risk for hypertensive complications before the clinical manifestations of the disorder.

Adult↗

PubMed2003

Eczematous plaques related to unfractionated and low-molecular-weight heparin in pregnancy: cross-reaction with danaparoid sodium.

The use of low-molecular-weight heparin has been expanded to prevent pregnancy complications such as pregnancy loss, intra-uterine growth restriction and severe early-onset pre-eclampsia in high-risk patients with evidence of acquired or congenital thrombophilia. Therefore, the number of patients with side effects from low-molecular-weight heparin is expected to increase. We describe two women with infiltrating patchy plaques that developed in reaction to low-molecular-weight heparin during pregnancy. In the first patient, a switch to other formulations of heparin and heparinoid failed; the second patient, however, did well when enoxaparin was replaced with dalteparin. This report confirms the risk of skin reactions to enoxaparin and dalteparin, and reports on a skin reaction associated with danaparoid sodium in a pregnant woman.

Adult↗

PubMed2002

The elevated plasma lipoprotein(a) concentrations in preeclampsia do not precede the development of the disorder.

We sought to determine whether maternal plasma lipoprotein(a) [Lp(a)] levels are elevated in the second trimester, before the development of preeclampsia and other obstetrical complications, in women at risk. In the first part of the study (cross-sectional), plasma concentrations of Lp(a) were compared among 16 women with preeclampsia, 35 normotensive pregnant women and 18 healthy nonpregnant women. In the second part (nested case-control), blood samples were collected prospectively from 82 women at risk of preeclampsia, at 14-24 weeks of gestation, and Lp(a) levels were compared between those in whom preeclampsia or other obstetrical complications developed and those in whom they did not. In the cross-sectional study, plasma concentrations of Lp(a) were significantly higher in women with preeclampsia than in normotensive pregnant and healthy nonpregnant women (41 +/- 31 vs. 24 +/- 16 and 15 +/- 10 mg/dl, respectively; P=.001). Of the 82 women in the second part of the study, 9 (11%) developed preeclampsia and 19 (23%) had complications such as intrauterine growth restriction, preterm delivery and fetal or neonatal loss. There were no differences in plasma Lp(a) concentrations between the women with preeclampsia and those without complications, though Lp(a) levels were significantly higher in women with other complications than in those with either preeclampsia or uncomplicated pregnancies (40 +/- 29 vs. 17 +/- 13 or 28 +/- 18 mg/dl, respectively; P=.05). In conclusion, elevated plasma levels of Lp(a), associated with clinically established preeclampsia, are not detected before the appearance of the disorder in pregnant women at risk.

Adult↗

PubMed2002

Mode of delivery following successful external cephalic version.

Mode of delivery of pregnancies following successful external cephalic version (ECV) was evaluated in a retrospective case-controlled study. Successful ECV was performed in 105 of 223 (47%) attempts. Data were obtained in 96 of 105 (91.4%) pregnancies that were matched 1:2 fashion to the next consecutive singleton deliveries for maternal age, gravidity, parity, and ethnic origin. The groups were compared for mode of delivery, indications for cesarean section (CS) and instrumental delivery, gestational age at delivery, birth weight and Apgar score. There was no significant difference between the groups in maternal age or the rates of low 5-minute Apgar score (</= 7) and instrumental delivery. The rate of intrapartum CS in the study group was 19.8% (19 of 96), which was 3.2 times higher than that of the control group (12 of 192, 6.25%, p <0.001). Gestational age at delivery was significantly higher in the study group (40.0 +/- 1.2 vs. 39.3 +/- 1.5 weeks, p <0.001) as was the birth weight (3,411 +/- 426 vs. 3,291 +/- 490 g, p = 0.041). There was no significant difference in the rate of non-reassuring fetal heart rate patterns, but the rates of labor dystocia and malpresentation were higher in the study group. Patients in the study group who underwent CS and instrumental delivery ( n = 24) were characterized by a significantly higher nulliparity rate and birth weight and a near-significantly longer interval from ECV to delivery. In conclusion, pregnancies after a successful ECV are at higher risk of CS, which is not associated with fetal distress, but might be attributable to higher rates of labor dystocia and malpresentation, higher nulliparity rate birth weight, and gestational age at delivery. ECV to delivery interval may also be an important factor.

Adult↗

PubMed2002

Plasma levels of vitamin E in pregnant women prior to the development of preeclampsia and other hypertensive complications.

Our aim was to investigate whether decreased levels of vitamin E can be measured during the early stages of pregnancy in women at risk of developing preeclampsia or other associated complications before the onset of the clinical syndrome. We prospectively measured the plasma concentrations of vitamin E in 62 pregnant women at 7-32 weeks of gestation who were at risk of developing preeclampsia and other complications, before the appearance of clinical signs. The results were compared with those of 16 healthy controls. Of the 62 study patients, 8 (13%) developed preeclampsia, and 18 (29%) had other complications, such as intrauterine growth restriction (n = 8), fetal or neonatal loss (n = 9), and preterm delivery (< or = 30 weeks of gestation; n = 7). Both gestational age at delivery and birth weight were significantly lower in the patients with complications than in the healthy controls. However, there were no significant differences in vitamin E levels between women who developed preeclampsia or other complications and those who did not. There was no significant correlation between plasma vitamin E and creatinine concentrations. A significant positive correlation was found in both the complicated and normal pregnancies between plasma vitamin E concentration and gestational week of blood collection (R = 0.485, p < 0.001, and R = 0.718, p = 0.004, respectively). We conclude that the vitamin E concentrations are not decreased prior to the development of preeclampsia or other complications in women at risk.

Adult↗

PubMed2002

[New developments in labor induction].

INTRODUCTION: Misoprostol is a prostaglandin E1 analogue. During the last 8 years it has been examined in clinical trials in obstetrics for the induction of labor and cervical ripening. AIM: To review the current literature concerning its efficacy, safety and dosage for induction of labor. MATERIALS AND METHODS: This review is based on the results of 33 articles published during the years 1993-2001. Data was gathered by searching the internet at Pubmed, Medline and the list of references in the relevant articles. RESULTS: Misoprostol is a highly effective medication for the induction of labor in comparison to prostaglandin E1 or oxytocin. It is stable for years and the cost of treatment is low. Its disadvantage is based on its tendency to evoke increased uterine activity such as tachysystole and hyperstimulation and the fear of uterine rupture. These disadvantages can be overcome by safety measures such as decreasing the dose, increasing time intervals between doses and careful selection of patients. CONCLUSIONS: Misoprostol is an important and efficient medication in obstetrics for cervical ripening and induction of labor. Therefore, we believe it is appropriate to start clinical trials in Israel too.

Female↗