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Biomedical subjects

M P David

Publications and source records attributed to M P David.

At least 19 recordsLinked to original sources
PubMed1995

Ultrasonic "honeycomb" appearance of uterine submucous fibroids undergoing cystic degeneration.

Uterine fibroids are the most common of uterine benign tumors. Generally, the ultrasonic appearance of uterine fibroids is typical, and diagnosis is uncomplicated. However, the sonographic characteristics of fibroids undergoing cystic degeneration, and especially those of the submucous type, may be misleading. We present a series of submucous fluids with cystic degeneration in peri- and postmenopausal women showing a distinct sonographic "honeycomb" pattern erroneously diagnosed as endometrial hyperplasia. The correct diagnosis was established by hysteroscopy.

Cysts↗
PubMed1995

In vitro fertilization and oocyte donation in women 45 years of age and older.

OBJECTIVE: To assess the reproductive potential in women > or = 45 years of age. DESIGN: Retrospective analysis. SETTING: In vitro fertilization-embryo transfer unit, standard IVF and oocyte donation programs. PATIENTS: One hundred twenty-seven patients > or = 45 years old who applied for treatment of infertility. INTERVENTION: Thirty-one patients underwent 52 treatment cycles in standard IVF. Ninety-six patients underwent 220 oocyte donation cycles. RESULTS: Of the 52 standard IVF cycles, oocytes were retrieved successfully in only 32. Of these, fertilization and ET were performed in 21 cycles. None of these treatment cycles resulted in a clinical pregnancy. Of the 220 oocyte donation cycles, fertilization and ET were accomplished in 189 cycles. These resulted in 33 (17.5% per transfer) clinical pregnancies. CONCLUSIONS: These results suggest that oocyte donation may extend the reproductive potential in women > or = 45 years old when little hope is offered by standard IVF.

Embryo Transfer↗
PubMed1995

In vitro fertilization for women with pure tubal occlusion: the impact of short gonadotropin-releasing hormone agonist treatment.

OBJECTIVE: To evaluate the impact of a short GnRH agonist (GnRH-a) protocol on follicular and luteal characteristics and treatment outcome in women undergoing IVF for isolated pure tubal occlusion. DESIGN: A prospective randomized study. PATIENTS: Eighty patients with pure tubal occlusion undergoing IVF for the first time. INTERVENTIONS: Patients in group 1 (control group) were administered hMG from day 3 of the menstrual cycle. Patients in group 2 were administered 900 micrograms/d buserelin acetate intranasally from day 1 of the menstrual cycle, followed by hMG administration from day 3. Buserelin acetate was discontinued on the day of hCG administration. MAIN OUTCOME MEASURES: Information collected included E2 levels and follicular growth throughout cycle, amount of hMG required for stimulation, number of oocytes retrieved, fertilization, pregnancy, and cancellation rates. RESULTS: The short GnRH-a protocol resulted in significantly higher E2 levels and required less hMG for stimulation. However, the number of follicles aspirated, number of oocytes retrieved, fertilization rate, number of embryos transferred, pregnancy rate, and cancellation rate in both groups were comparable. CONCLUSIONS: The findings suggest that administration of a short protocol of GnRH-a to patients with pure tubal occlusion has no obvious superiority in comparison with hMG alone, except for the lower amount of hMG required for ovarian stimulation.

Administration, Intranasal↗
PubMed1995

Transfer of six or more embryos improves success rates in patients with repeated in vitro fertilization failures.

OBJECTIVE: To examine the results of six or more embryos transferred to patients whose IVF-ET cycles repeatedly met with failure. DESIGN: Prospective clinical evaluation of pregnancy rates and pregnancy outcome. SETTING: IVF-ET Unit. PATIENTS: Seventy-two IVF patients who had failed at least four previous IVF cycles. INTERVENTIONS: Forty-one patients (group A) received six or more embryos, and 31 patients (group B) chose to receive five embryos. MAIN OUTCOME MEASURES: Per embryo implantation rate, pregnancy rate, multiple pregnancies, and outcome were evaluated. RESULTS: With the transfer of six or more embryos, the pregnancy rate was significantly higher than with the transfer of five embryos (56% versus 29%, respectively). This was associated with a slight, but insignificant, increase in multiple gestations. No difference in pregnancy outcome was noted among the groups. CONCLUSIONS: Patients who have had repeated IVF failures may have higher pregnancy rates if six or more embryos are transferred in subsequent cycles.

Adult↗
PubMed1995

Uterine preparation with estrogen for oocyte donation: assessing the effect of treatment duration on pregnancy rates.

OBJECTIVE: To assess the effect of the duration of uterine preparation with E2 on pregnancy rates (PRs) in oocyte donation. DESIGN: A retrospective study. SETTING: IVF-ET Unit, oocyte donation program. PATIENTS: Four hundred eleven patients undergoing 865 ET cycles after oocyte donation. Uterine preparation consisted of 6 mg/d E2 valerate. The duration of treatment varied according to the availability of the oocytes for donation. Progesterone, 100 mg/d, was added upon oocyte retrieval. Patients were divided into seven groups according to the duration of uterine preparation with E2, in 5-day ranks. MAIN OUTCOME MEASURES: Pregnancy rates per ET according to the duration of uterine preparation. RESULTS: No differences were noted in the mean age, number of oocytes received, fertilization rates, or number of embryos transferred when comparing all groups. Pregnancy rates ranged from 19% to 27% for E2 treatment of 5 to 35 days. CONCLUSION: Endometrial preparation in anonymous oocyte donation programs is achieved with continuous administration of E2 until oocytes become available. Our results show that this treatment may be extended for as long as 5 weeks with no significant decrease in PRs.

Adult↗
PubMed1995

Cervical cerclage for the incompetent cervical Os. Improving the fetal salvage rate.

The precerclage and postcerclage term delivery rate (TDR), premature delivery rate (PDR) and late abortion rate (LAR) were evaluated in 260 parturients undergoing elective cerclage at 12-16 weeks' gestation. The TDR increased from 0.49 to 0.78, the PDR dropped from 0.35 to 0.18, and the LAR dropped from 0.16 to 0.04. The rate of early and late complications was acceptable, and the fetal survival rate was significantly improved. The fetal salvage rate increased from 0.73 to 0.92, establishing a fetal salvage ratio of 1.26. Based on this experience, cerclage placement in cases of incompetent cervical os may prolong the duration of pregnancy and improve the outcome.

Abortion, Spontaneous↗
PubMed1995

High progesterone levels adversely affect embryo quality and pregnancy rates in in vitro fertilization and oocyte donation programs.

OBJECTIVE: To assess the effect of P levels on oocyte and embryo quality and pregnancy rates (PRs) in IVF and oocyte donation. DESIGN: Retrospective analysis of PRs in ovum donors and their recipients with regard to P levels on day of hCG administration. SETTING: In Vitro Fertilization Units, oocyte donation programs. PATIENTS: In vitro fertilization patients who agreed to donate oocytes were treated by hMG alone (53 cycles) or in combination with a GnRH analog (122 cycles). INTERVENTIONS: Uterine preparation in oocyte recipients consisted of 6 mg/d E2 valerate. Progesterone (100 mg/d) was added when oocytes became available. Hormonal treatment was continued until 12 weeks of gestation. RESULTS: Using a series of Fisher's Exact Tests, a critical threshold for P was identified at 1.9 ng/mL (conversion factor to SI units, 3.185). With elevated P levels (> 1.9 ng/mL), lower PRs were noted for the donors (7.1% versus 17%), as well for the recipients (8.3% versus 26.7%). CONCLUSIONS: Exposure to elevated P levels resulted in lower PRs for the donors and significantly lower PRs in the recipients. Because the endometria in the recipients were prepared uniformly, we conclude that this is the result of detrimental effects of P on oocyte or embryo quality.

Adult↗
PubMed1994

Outpatient versus inpatient cervical cerclage.

The outcomes in 125 cases of elective, outpatient cerclage placement were compared to those in 101 cases of elective, inpatient cerclage placement with the same technique at the same institution. There was no difference between the two groups in the rates of early and late complications or in the effect of the procedure on the duration of gestation. As expected, a statistically significantly shorter hospital stay occurred in the outpatient group. The outpatient procedure is as effective as the inpatient one, with no increased risk of early and late complications, and offers patients a shorter absence from home, thus possibly decreasing their anxiety, and considerable financial savings.

Adult↗
PubMed1992

Fetal malformations associated with chronic polyhydramnios in singleton pregnancies.

Forty-one congenital malformations were found in 28 newborns in a group of 197 cases of chronic polyhydramnios in singleton pregnancies. Of these, a total of 61% (17/28) was antenatally diagnosed ultrasonically. Nine newborns (4.5%) had malformations of the central nervous system (CNS), 9 (4.5%) cardiovascular malformations, 8 (4.1%) musculoskeletal anomalies, 7 (3.6%) malformations of the urinary and reproductive system, 4 (2%) respiratory system anomalies and 3 (1.6%) anomalies of the gastrointestinal system. Chromosomal abnormalities were found in three cases. As the association of polyhydramnios with fetal congenital anomalies is quite high (14.2% in our series), it is imperative to make a major effort to antenatally detect as many cases as possible. This means that in the case of hydramnios the following are required: ultrasound examination by an expert, echo ultrasonography when no other abnormalities are detected, and maybe even a chromosomal analysis.

Brain↗
PubMed1992

[Endometrial sonographic growth pattern in ovulatory cycles].

Ultrasonic measurements of endometrial thickness and recording of the echogenic pattern were performed daily throughout an ovulatory cycle in 20 women, aged 20-30, who had normal ovulatory cycles. There were 10 women in whom the cycle terminated in pregnancy and 10 in whom it ended in menstruation. The echogenic pattern of the endometrium was similar in both groups, but the endometrial growth pattern showed a significantly thicker endometrium (p less than 0.05) 8-13 days after ovulation in those who became pregnant.

Adult↗
PubMed1992

High initial values of beta-subunits of human chorionic gonadotropin in ovum donation pregnancies indicate better implantation.

Fifty-five patients were treated by ovum donation, and a control group of 165 patients underwent IVF. The number of pregnancies obtained were 28 and 25, respectively. The initial beta-hCG values, as well as the PRs and implantation rates, in the ovum donation series were significantly higher than those of the IVF series. The clinical significance and potential application of these observations are discussed.

Chorionic Gonadotropin↗
PubMed1992

Embryo reduction in multifetal pregnancies using saline injection: comparison between the transvaginal and the transabdominal approach.

A total of 30 patients with multifetal pregnancies, all resulting from treatment with superovulatory agents or assisted reproductive techniques, underwent embryo reduction. All patients had three or more fetuses (one sextuplet, two quintuplets, seven quadruplets and 20 triplets). The procedure was carried out using intra-embryonal injection of 0.9% sodium chloride solution. Embryo reduction was carried out via the transabdominal approach in 10 patients, performed at 11-12 weeks of gestation, and via the transvaginal route in 20 other patients, at 8-10 weeks of gestation. In the transabdominal group, one patient aborted following repeated attempts at embryo reduction while the other nine gave birth to healthy newborns (eight twins and one triplet). In the transvaginal group, four pregnancies are currently ongoing (all beyond 28 weeks of gestation), 14 pregnancies resulted in a delivery of at least one live newborn (13 twins and one singleton), one patient had a late abortion at 24 weeks' gestation and another was delivered at 27 weeks' gestation due to severe pre-eclampsia. Transvaginal ultrasound-guided needle procedures are commonly practised in most in-vitro fertilization units. The employment of this route for embryo reduction, performed at an earlier gestational age and with the use of a non-toxic substance such as 0.9% saline solution, is advocated.

Abdomen↗
PubMed1992

Obstetric outcome in women with congenital uterine malformations.

Ninety-eight cases of congenital uterine malformations were diagnosed with hysterosalpingography (HSG). Symmetric uterine malformations, composed of bicornuate uterus, uterus didelphys and septate uterus, constituted 80% of the cases. Of them, 75% were of the bicornuate type. Infertility (55%) and a suggestion of cervical incompetence (24%) were the main indication for HSG. Premature deliveries (29%), spontaneous first-trimester abortions (24%), ectopic pregnancies (3%), abnormal fetal presentations (23%) and a high cesarean section rate (27.5%) occurred in those patients. The highest rate of first-trimester abortions (47%) and the lowest rate of term deliveries (21%) occurred in the group with T-shaped uteri as compared to a 7% rate of early abortions (P less than .05) and 61% rate of term deliveries (P less than .03) in the unicornuate uterus group. In 30% of the patients with uterine malformations, cervical incompetence was diagnosed. Improved obstetric outcomes occurred in patients treated with cervical cerclage. There was a statistically significant difference between the number of premature deliveries and spontaneous late abortions in the group without cerclage (50%) and that with cerclage (21%) (P less than .001).

Abortion, Spontaneous↗
PubMed1992

Prostaglandin for enhancing bladder function after vaginal surgery. Does it work?

Fifty women underwent vaginal hysterectomy with or without anterior and posterior colporrhaphy. After the operations the women were allocated randomly to one of three groups. One group (17 patients) received daily vaginal suppositories of 10 mg of prostaglandin E2. The second group (15) received a daily intravesical solution of 50 micrograms of prostaglandin F2 alpha dissolved in 100 mL of normal saline. The third group (18) received a daily instillation of 100 mL of saline and served as the control group. The postvoiding residual urinary volume was checked daily through a suprapubic catheter, which was removed once the residual volume was less than 50 mL. The prostaglandin did not shorten the time required for postoperative bladder drainage. The rates of febrile morbidity and hospital stay were the same in all three groups. Since most of the women in the study voided spontaneously within three days, the "sit and wait" approach seems reasonable in such patients, and prophylactic treatment to enhance bladder function after vaginal operations does not seem justified.

Administration, Intravesical↗