Biomedical subjects

Moshe Hod

Publications and source records attributed to Moshe Hod.

At least 19 recordsLinked to original sources

PubMed2004

Induction of labor with prostaglandin E2 in women with previous cesarean section and unfavorable cervix.

OBJECTIVE: To study the pregnancy outcome of induction of labor with prostaglandin E2 (PGE2) in women with one previous lower segment cesarean section. METHODS: A retrospective cohort design was used. The study sample included 1028 consecutive women with one previous cesarean section, of whom 97 underwent induction of labor (study group) and 931 were admitted with spontaneous onset of labor (control group). Vaginal tablets of PGE2 were used for cervical ripening in the study group. Mode of delivery, neonatal outcome, indications for cesarean section, and rate of uterine rupture were compared between the groups. RESULTS: There were no significant differences between the study and control groups in mean (+/-S.D.) maternal age (30.9 +/- 4.7 years versus 31.2 +/- 4.8 years, P = 0.6), gestational age at delivery (39.2 +/- 1.8 weeks versus 39.3 +/- 1.6 weeks, P = 0.36), overall rate of cesarean section (36% versus 37.3%, P = 0.8), rates of low 5-min Apgar score < or =7 (3.1% versus 3.7%, P = 0.67) or cesarean section performed for nonreassuring fetal heart rate (6.1% versus 3.1%, P = 0.1). There were four cases of uterine rupture, all in the control group compared to none in the study group (nonsignificant). CONCLUSION: The findings suggest that induction of labor in women with one previous cesarean section does not increase the risk of cesarean section rate and does not adversely affect immediate neonatal outcome. We cautiously suggest that when there is no absolute indication for repeated cesarean section, induction of labor may be considered.

Adult↗

PubMed2004

Induction of labor in pregnancies with suspected large-for-gestational-age fetuses and unfavorable cervix.

OBJECTIVES: To evaluate our single-center, single-team experience with induction of labor in pregnancies with suspected large for gestational age (LGA) fetuses. STUDY DESIGN: A retrospective case-controlled design was used. Non-diabetic patients with a suspected LGA fetus (estimated fetal weight > or =90th percentile) (group 1, n = 135) were compared with healthy patients admitted for elective induction of labor for either post-date pregnancy or a subjective perception of decreased fetal movements in the presence of normal fetal heart monitoring and biophysical profile (group 2, n = 326), and with healthy women with normal pregnancies and spontaneous onset of labor (group 3, n = 574). RESULTS: There were no between-group differences in maternal age, parity, number of prostaglandin E2 (PGE2) tablets used, instrumental delivery rate or Apgar scores. The rate of cesarean section (CS) was significantly higher in the study group (33.3%) than in group 2 (17.8%, P = 0.001) and group 3 (10.6%, P = 0.004), although this difference disappeared when the multiparous women were analyzed separately (study group: n = 58, 10.3% versus group 2: n = 169, 7.7% and group 3: n = 308, 7.8%, P = 0.6). A logistic regression model (R2 = 0.385, P < 0.001) was used to control for maternal and gestational age, nulliparity rate, number of PGE2 tablets used, birth weight, and diagnosis (group 1 versus group 2) as predictors of mode of delivery. On stepwise (forward-likelihood) analysis, only nulliparity (odds ratio (OR) 10.0, 95% confidence interval (CI) 2.8-35.6, P < 0.001) and maternal age (OR 1.2, 95% CI 1.06-1.36, P = 0.002) were independently and significantly associated with increased risk of CS. CONCLUSIONS: Induction of labor for suspected LGA fetuses, if performed at all, should be reserved for multiparous women.

Adult↗

PubMed2004

Active induction management of labor for diabetic pregnancies at term; mode of delivery and fetal outcome--a single center experience.

OBJECTIVES: To evaluate the mode of delivery in diabetic pregnancies at term following induction of labor with vaginal application of prostaglandin E2 (PGE2), and to identify possible predictors of successful vaginal delivery. PATIENTS AND METHODS: The study group consisted of 105 women with diabetic pregnancies at term admitted for induction of labor; 84 (80%) had gestational diabetes (GDM) and 21 (20%) type 1 diabetes. Findings were compared with women who underwent elective induction of labor (n=115), and women with normal spontaneous onset of labor (n=510). Women with previous cesarean section (CS) were excluded from both study and control groups. RESULTS: Maternal age and gravidity were significantly higher in the study group than the control groups (age: 31.4+/-5, 28+/-5.0 and 28.1+/-4.8 years, respectively; gravidity: 3.0+/-1.9, 2.5+/-1.6, and 2.1+/-1.4, respectively; P<0.001 for both) and gestational age and nulliparity rate were significantly lower (gestational age: 38.6+/-1.1, 40.2+/-1.3 and 39.3+/-2.7 weeks, respectively; nulliparity: 34.6, 45.2, 51.6%, respectively; P<0.002 for both). There were no between-group differences in the incidence of oligohydramnios, number of PGE2 applications used, birth weight, rate of non-reassuring fetal heart rate pattern leading to CS, and rate of low 5 min Apgar score (<7). The rate of CS in the study group (18.2%) was significantly higher than in the spontaneous labor group (9%) but similar to the elective induction group (14.8%). On stepwise analysis, only nulliparity (OR 4.56, 95% CI 1.11-18.67, P=0.035) was independently and significantly associated with increased risk of CS. Within the study group (R2=0.257, P=0.002), type 1 diabetes (OR 2.4, 95% CI 1.04-5.51) was independently and significantly associated with increased risk of CS. CONCLUSION: In diabetic pregnancies, induction of labor at term with vaginal PGE2 is successful in approximately 82% of patients, but yields a significantly higher CS rate compared to uncomplicated pregnancies. Nulliparity and diagnosis of type 1 diabetes are independently and significantly associated with increased risk of CS. CONDENSATION: In diabetic pregnancies, induction of labor at term is successful in 82% of patients, but yields higher CS rates compared to uncomplicated pregnancies.

Adult↗

PubMed2004

The postprandial glucose profile in the diabetic pregnancy.

OBJECTIVE: A controversy exists regarding the time to monitor blood glucose in the diabetic pregnancy (60 or 120 minutes after meals). Using a novel approach that provides continuous measurement of blood glucose, we sought to determine postprandial glucose profile in the diabetic pregnancy. STUDY DESIGN: Subjects were connected to a continuous glucose monitoring system for 72 consecutive hours. A continuous glucose monitoring system measures the interstitial glucose levels in subcutaneous tissue every 5 minutes. Women were instructed to record the time of each meal during the study period. For each meal, the first 240 minutes were analyzed. RESULTS: Sixty-five women participated in the study: 26 women were treated by diet alone; 19 women received insulin therapy, and 20 women had type 1 diabetes mellitus. The time interval from meal to peak postprandial glucose levels was similar in all the evaluated types of diabetic pregnancies and in good and poor control insulin-treated patients with gestational diabetes mellitus (approximately 90 minutes). Failure to return to preprandial glucose values within a 3-hour observation period was identified in approximately 50% of the patients. A similar postprandial glucose peak time was obtained for breakfast, lunch, and dinner in all study groups. Postprandial hypoglycemia events were noted in approximately 10% of the meals and occurred about 160 minutes after mealtime. CONCLUSION: The time interval for postprandial glucose peak in diabetic pregnancies is approximately 90 minutes after meals throughout the day and is not affected by the level of glycemic control. This information should be considered in the treatment of diabetes mellitus in pregnancy.

Adult↗

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

Primary herpes simplex virus type 1 gingivostomatitis during the second and third trimester of pregnancy: foetal and pregnancy outcome.

Primary herpetic gingivostomatitis during pregnancy is a relatively rare phenomenon with no clear management guidelines. We describe 4 cases of primary herpetic gingivostomatitis during pregnancy and review the literature. The diagnosis in all cases was based on clinical manifestations and serology and culture findings. Two of the women received intravenous rehydration. Acyclovir, offered in 2 cases, was refused. Delivery was normal in all 4 cases, with good neonatal outcome, similar to findings in the literature (6 cases). Herpetic gingivostomatitis in the second and third trimester of pregnancy does not appear to be associated with adverse foetal effects. More data are needed to define the risk of this infection during pregnancy.

Adult↗

PubMed2004

Undiagnosed asymptomatic hypoglycemia: diet, insulin, and glyburide for gestational diabetic pregnancy.

OBJECTIVE: The role of maternal hypoglycemia during pregnancy has not yet been established. We sought to estimate the prevalence of undiagnosed, asymptomatic hypoglycemic events that occur in diabetic patients. METHODS: All patients were evaluated using a continuous glucose monitoring system for 72 consecutive hours. The continuous glucose monitoring system measures in subcutaneous tissue interstitial glucose levels within a range of 40-400 mg/dL every 5 minutes for a total of 288 measurements per day. All patients were instructed regarding diabetic diet and assigned to pharmacological treatment as needed. Patients documented the time of food intake, insulin or glyburide administration, and all clinical hypoglycemic events. An asymptomatic hypoglycemic episode was defined as more than 30 consecutive minutes of glucose value below 50 mg/dL detected only by continuous glucose monitoring system reading without patient awareness. RESULTS: An evaluation of 82 patients with gestational diabetes was performed; 30 were insulin-treated, 27 were managed by diet only, and 25 were patients treated with glyburide. For purposes of comparison, data were obtained from 35 nondiabetic gravid women. Asymptomatic hypoglycemic events were identified in 19 of 30 (63%) insulin-treated patients and in 7 of 25 (28%) glyburide-treated patients. No hypoglycemic events were identified in patients with gestational diabetes mellitus treated by diet alone or in nondiabetic subjects. The mean recorded hypoglycemic episodes per day was significantly higher in insulin-treated patients (4.2 +/- 2.1) than in glyburide-treated patients (2.1 +/- 1.1), P =.03. In insulin-treated patients, the majority of the hypoglycemic events were nocturnal (84%), whereas in glyburide-treated patients, episodes were identified equally by day and night. CONCLUSION: Our data suggest that asymptomatic hypoglycemic events are common during pharmacological treatment in gestational diabetic pregnancies. We speculate that this finding may be explained by treatment modality rather than by the disease itself.

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

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↗

PubMed2004

Fetal weight estimation in diabetic pregnancies and suspected fetal macrosomia.

OBJECTIVE: To review the literature on the accuracy of sonographic estimated fetal weight (EFW) in diabetic pregnancies, specifically on its role in the prediction and clinical management of fetal macrosomia. METHODS: An English language literature search of Medline listings was performed to review the recently published data on sonographic fetal weight estimation in diabetic pregnancies and suspected fetal macrosomia. RESULTS: Ultrasound biometry used to detect macrosomia is characterized by low sensitivity, low positive predictive value, and high negative predictive value. Serial sonographic measurements and the use of additional examiners can increase the positive predictive value. Regardless of the formula used, the accuracy of the sonographic estimate decreases with increasing birth weight. Three-dimensional ultrasound and magnetic resonance imaging techniques are still investigational. To date, none of the management algorithms developed for selective interventions that are based on the sonographic EFW have demonstrated any efficacy in reducing the incidence of either shoulder dystocia or brachial plexus injury. CONCLUSIONS: The true value of ultrasonography in the management of fetal macrosomia may be its ability to rule out the diagnosis. Ultrasound-derived fetal weight estimates alone are not sufficient grounds for deciding the route of delivery. To assess the risk of macrosomia, other known risk factors should also be taken into account. To determine the mode of delivery, the clinical fetal weight estimate, subjective maternal weight estimate, and clinical assessment of pelvic capacity should be added to the sonographic fetal weight estimate, with consideration of the risk factors for macrosomia.

Birth Weight↗

PubMed2004

Assessment of iodine intake in the Israel coastal area.

BACKGROUND: Iodine intake is necessary to maintain normal thyroid function and prevent iodine deficiency disorders. In 1990, a resolution calling for universal salt iodination to eliminate iodine deficiency worldwide was taken by the World Health Organization and endorsed by some 130 countries. As of today, very little is known about iodine intake and the prevalence of iodine deficiency disorders in Israel, and the authorities do not require iodine enrichment of regular salt. OBJECTIVE: To assess the current level of iodine intake in an unselected group of residents from the Israeli costal area. METHODS: Spot urine samples were collected from three groups: Group A comprising 51 pregnant women attending the Womens Health Clinic at our institution, with a mean age of 32 years and at gestational week 28; group B consisting of 35 healthy subjects, mean age 38; and group C consisting of 16 euthyroid subjects harboring nodular goiters. Tap water and mineral water were also analyzed for iodine content. Iodine concentration was measured using the catalytic reduction of ceric ammonium sulfate method. RESULTS: When considering all groups together the median urinary iodine concentration was 143 micrograms/L, with 27% of the study population having concentrations under 100 micrograms/L and 7.8% under 50 micrograms/L. Values were distributed similarly between sites of residency, and no significant differences were seen between groups. The mean iodine concentration for tap drinking water was 22.8 micrograms/L (range 0.5-53.5 micrograms/L) and for mineral water 7 micrograms/L (range 0-15 micrograms/L). CONCLUSIONS: Overall, iodine intake appeared to be satisfactory in our study population, however mild deficiency may exist in up to 26% of this group. A nationwide survey is needed to better determine the status of iodine intake in Israel, allowing for recommendations on salt-iodine enrichment in the future.

Adult↗

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

Continuous glucose monitoring for the evaluation of gravid women with type 1 diabetes mellitus.

OBJECTIVE: To compare the daily glycemic profile reflected by continuous and intermittent blood glucose monitoring in pregnant women with type 1 diabetes and to compare the treatment protocols based on the two monitoring methods. METHODS: The study sample consisted of 34 gravid patients at gestational weeks 16-32, with type 1 diabetes being treated by multiple insulin injections. Data derived from the continuous glucose monitoring system for 72 hours were compared with finger stick glucose measurements performed 6-8 times per day. During the study period, patients documented the time of food intake, insulin injections, and hypoglycemic events. Data on demographics, gravidity, parity, body mass index, hemoglobin A1c, and fructosamine levels were collected for each patient. RESULTS: An average (+/- standard deviation) of 780 +/- 54 glucose measurements was recorded for each patient with continuous glucose monitoring. The mean total time of hyperglycemia (glucose level greater than 140 mg/dL) undetected by the finger stick method was 192 +/- 28 minutes per day. Nocturnal hypoglycemic events (glucose level less than 50 mg/dL) were recorded in 26 patients; in all cases, there was an interval of 1-4 hours before clinical manifestations appeared or the event was revealed by random blood glucose examination. Based on the additional information obtained by continuous monitoring, the insulin therapeutic regimen was adjusted in 24 patients (70%). CONCLUSION: Continuous glucose monitoring can diagnose high postprandial blood glucose levels and nocturnal hypoglycemic events that are unrecognized by intermittent blood glucose monitoring and may serve as a basis for determining treatment regimens. A large, prospective study on maternal and neonatal outcome is needed to evaluate the clinical implications of this new monitoring technique.

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↗