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Biomedical subjects

P Jakobi

Publications and source records attributed to P Jakobi.

At least 19 recordsLinked to original sources
PubMed1998

The outcome of abdominally delivered triplets and twins: a matched case-control study.

OBJECTIVE: To compare the outcome of matched triplets and twins delivered by cesarean section by order of delivery. STUDY DESIGN: 39 sets of triplets delivered abdominally were matched to 39 sets of twins also delivered by cesarean section in the same gestational age. The newborns outcome according to their birth order was analyzed. RESULTS: The mortality rate of triplets was twice than that of matched twins. While first born triplets had mortality rates similar to the first and second twins, there was a threefold increase in mortality rates of the second and third triplets as compared to the first triplet or twin. CONCLUSIONS: Triplets have a poorer outcome than twins even when they are delivered abdominally at the same gestational age. These differences are particularly noted in the second and third newborns.

Case-Control Studies↗
PubMed1997

Sonographic measurements of the umbilical cord in pregnancies complicated by gestational diabetes.

The aim of the present study was to investigate the umbilical cord measurements in pregnant patients with gestational diabetes. We found that the umbilical cord was significantly larger in fetuses of mothers with gestational diabetes than in the normal population and that the main increase in the width is attributed to an increase in Wharton jelly content. It is suggested that this finding may be an additional parameter that can differentiate between the appropriate-for-gestational-age fetus from a normal pregnancy and that from a pregnancy in a mother with gestational diabetes, and between the macrosomic fetus of a diabetic pregnancy from the genetically large fetus.

Birth Weight↗
PubMed1996

Multiple fetal intracardiac echogenic foci: not always a benign sonographic finding.

Isolated left-sided echogenic foci in the fetal heart are considered as a benign condition, probably representing a normal variant of the development of papillary muscles. The objective of the present study was to evaluate the incidence and significance of multiple or diffuse echogenic foci in the fetal heart. We analysed retrospectively 25 725 ultrasound examinations conducted for fetal malformations between 12 and 24 weeks' gestation. In the study group, echogenic intracardiac foci were observed in 44 cases (0.17 per cent). In 35 fetuses, these foci were confined to the region of the papillary muscles/chordae tendinae as an isolated finding in the left side of the heart. All these fetuses had an uneventful neonatal follow-up. However, in nine of these cases, diffuse echogenic foci were demonstrated in various regions of the fetal heart, five of them with involvement of the right ventricle. In five of the nine cases, other major pathologies were found. In one case, a missed abortion occurred and in one case of early termination of pregnancy, calcifications were demonstrated in the endocardium on histological examination. Only in two of the nine fetuses was the outcome uneventful. Our findings suggest that diffuse echogenicity in the fetal heart, especially when the right ventricle is also involved, may signal a poor prognosis and deserves a further search for associated pathologies. This is in contrast to the benign character of an isolated left-sided echogenic focus.

Adult↗
PubMed1996

The effect of isosorbide dinitrate on uterine artery and umbilical artery flow velocity waveforms at mid-pregnancy.

OBJECTIVE: To study the effect of isosorbide dinitrate, a nitric oxide donor, on the maternal cardiovascular system and on uterine and umbilical artery blood flow velocities in mid-pregnancy. METHODS: Eighteen women with low-risk pregnancy at 17-24 weeks' gestation were given a single 5-mg dose of sublingual isosorbide dinitrate, a nitrovasodilator. Blood flow velocity waveforms in the ascending uterine artery and in the umbilical artery were measured by an image-directed, pulsed color Doppler ultrasound scan before and after the medication was administered. Maternal blood pressure (BP) and heart rate were also obtained. RESULTS: The mean arterial BP decreased from 86 mmHg (95% confidence interval [CI] 72-99) to a nadir of 73 mmHg at 6 minutes (95% CI 61-85, P < .04). Mean maternal heart rate increased from 85 beats per minute (95% CI 80-90) to 96 beats per minute at 6 minutes (95% CI 87-105, P < .01). Mean systolic-diastolic flow velocity ratio (S/D) in the umbilical artery rapidly declined from 4.18 (95% CI 3.80-4.56), reaching a nadir of 3.12 at 6 minutes (95% CI 2.65-3.84, P < .001). The S/D in the uterine artery decreased from 4.83 (95% CI 3.99-5.56) to a nadir of 4.02 at 10 minutes (95% CI 3.41-4.63, P < .001). CONCLUSION: Isosorbide dinitrate, a donor of nitric acid, lowers mean maternal BP and reduces the Doppler impedance in the umbilical and uterine arteries. This drug could prove to be beneficial when endothelial cell dysfunction leads to insufficient synthesis and release of endothelium-derived relaxing factor, resulting in generalized vasoconstriction and increased resistance to flow in the uteroplacental circulation.

Adolescent↗
PubMed1996

Intracranial fetus-in-fetu.

Fetus-in-fetu is an extremely rare tumor diagnosed in utero. We present a case report of prenatal diagnosis of intracranial fetus-in-fetu.

Adult↗
PubMed1996

Effect of vibroacoustic stimulation on fetal meconium passage in labor.

It has been suggested that vibroacoustic stimulation might be stressful to the fetus. The present study was designed to evaluate whether the stimulus induces passage of meconium in labor. Patients in labor at term with healthy fetuses and intact membranes were randomized to a vibroacoustic stimulation or sham test. The incidence of meconium was the same in both groups. Pregnancy outcome variables were also similar in both groups. In conclusion, vibroacoustic stimulation does not increase the incidence of meconium passage of labor of healthy fetuses.

Acoustic Stimulation↗
PubMed1996

Sonographic measurement of amniotic fluid volume in the first trimester of pregnancy.

The sonographic estimate of amniotic fluid volume from 7 to 13 weeks of gestation in 95 pregnancies was calculated. Amniotic fluid volume increased from 1.5 ml at 7 weeks to 25 ml at 10 weeks and 100 ml at 13 weeks. The nomograms constructed may be used in the objective evaluation of the fetal condition in the first trimester.

Amniotic Fluid↗
PubMed1995

Umbilical artery flow velocity during maternal cardiopulmonary bypass.

The fetal death rate associated with cardiac operations using cardiopulmonary bypass in pregnant women is as high as 9.5% to 29%. We present a case in which fetal heart rate and umbilical artery flow velocity waveforms were continuously monitored by transvaginal ultrasonography and analyzed in relation to events of the cardiopulmonary bypass. Our findings suggest that hypothermia during cardiopulmonary bypass has potentially deleterious effects on the fetus and should be avoided if possible.

Adult↗
PubMed1995

Massive vulvar edema in pregnancy. A case report.

Massive vulvar edema in pregnancy is a rarely reported condition. We treated a case of severe labial edema complicating pregnancy. Massive edema of the vulva appears to usually be a sequela of an underlying, systemic disease in pregnant women.

Adult↗
PubMed1994

Late-onset isolated cystic hygroma: the obstetrical significance, management, and outcome.

We add two cases of prenatally diagnosed late-onset isolated cystic hygroma to the eight cases reported previously in the English literature. The obstetrical significance, management, and outcome of this entity are reviewed. A retrospective study of late-onset isolated cystic hygromas delivered in one medical centre between 1978 and 1992 was made. The medical records of these newborns served as the basis of the present report. A Medline search of the English literature was carried out. Over a period of 15 years, we observed 11 cases of late-onset congenital isolated cystic hygroma, two of whom had prenatal sonographic diagnosis. In one case, a Caesarean section was performed due to a huge lesion. All cases underwent surgical excision with a favourable outcome. Of the eight prenatally diagnosed cases reported previously, one died at bith due to inability to ventilate and two required a tracheostomy. Late-onset isolated cystic hygroma should be differentiated from the early-onset nuchal cystic hygroma. The differential diagnosis is important, as late-onset isolated cystic hygroma does not require any prenatal intervention, but special awareness during labour and Caesarean section in extreme cases. Transport to a perinatal centre with expert neonatal, respiratory, and paediatric surgical care is recommended. The prognosis in general is favourable.

Cesarean Section↗
PubMed1994

Sonographic measurements of the umbilical cord and vessels during normal pregnancies.

Sonographic measurements of the umbilical cord and vessels were performed in 368 uncomplicated pregnancies, and nomograms of their growth were constructed. All measurements were obtained in appropriate for gestational age fetuses in pregnancies with accurate dating. From the above measurements, an estimate of Wharton's jelly quantity (expressed as square millimeters) was calculated. The nomograms presented add another biometric measurement of normally growing fetuses and may serve to differentiate between them and those who are found to have umbilical cord abnormalities.

Adult↗
PubMed1994

Post-cesarean section febrile morbidity. Antibiotic prophylaxis in low-risk patients.

A study was conducted to assess whether antibiotic prophylaxis in low-risk patients for post-cesarean febrile morbidity was beneficial and cost effective. In a randomized, prospective study, 167 patients received a single, 1-g dose of cefazolin before clamping of the cord, and 140 did not. In the group given prophylaxis the febrile morbidity and postoperative therapeutic antibiotic usage were significantly lower than in the group not given prophylaxis (9% vs. 17.9%, P = .035, and 6.5% vs. 20%, P < .001, respectively). We conclude that single-dose cefazolin prophylaxis is both beneficial and cost effective, even in patients considered to be at low risk of post-cesarean febrile morbidity. Since the value of antibiotic prophylaxis in high-risk patients is accepted, universal antibiotic prophylaxis in every cesarean section case is suggested.

Cefazolin↗
PubMed1993

The extremely low birthweight infant: the twenty-first century dilemma.

The survival rate of very low birthweight infants (weighing less than 1500 gm) has dramatically increased over the past two decades. Consequently, high-tech intensive care is offered to an increasing number of infants with borderline viability, previously considered as miscarriages. We reviewed the most recent literature on the results of intensive care used in the subgroup of extremely low birthweight infants, weighting less than 750 gm or 800 gm. Since definitions, management policies, and follow-up reports in this group of newborns are not consistent, the important statistical variables of incidence, mortality, and morbidity are incomplete and severely biased. In the past decade there was a growing tendency toward using a more active approach in caring for these infants. Most of the success is among the infants weighing 750 to 800 gm, with a survival rate in the range of 33 to 62%. However, the overall improvement in survival is small, with an extremely poor outlook for infants below 600 gm. The morbidity rate in the survivors is alarmingly high, reaching 70% and most common in infants with birthweight less than 600 gm. The available data show that virtually for every "healthy" surviving extremely low birthweight infant there is also at least one surviving child who is moderately to severely handicapped. The overall consequences and implications of high-tech care of these borderline viability infants, once considered as nonviable, are not necessarily improved over those of the former, less aggressive, approach. Since these results have grave consequences for the involved families and society, we urgently need to involve these parties more actively in decision making.

Decision Making↗
PubMed1993

Umbilical and arcuate uterine artery flow velocity measurements during acute hemodialysis.

Dialysis during pregnancy is a rare event associated with a poor outcome. The acute fluid volume shifts during hemodialysis are suspected to be one of the reasons for the high rate of complications during the procedure. This is the first report of uteroplacental and fetoplacental perfusion assessment during acute hemodialysis in pregnancy. The results of the Doppler measurements suggest that the maternal-fetal circulation can successfully tolerate acute volume shifts provoked by hemodialysis.

Adult↗
PubMed1993

Evaluation of prognostic factors for vaginal delivery after cesarean section.

Although the success rate of vaginal birth after cesarean section in selected patients is > 60%, most of these women elect the option of a planned repeat cesarean section. In this study our purpose was to evaluate the predictive value and relative importance of 15 prognostic factors by using univariate and multivariate analysis in order to refine the selection of patients for a trial of labor. The analyses were based on 261 patients with one prior cesarean section who were allowed a trial of labor. The final model resulted in six significant prognostic factors. The overall predictive value of the model was 68%. However, the predictive value for a successful vaginal delivery was excellent: 94.5% (139/147) of the women predicted to deliver vaginally actually did so. This group constituted 56% (147/261) of our candidates for vaginal delivery. The predictive value of the test for failure was only 33.3% (38/114); 66.6% of the women completed a vaginal delivery despite the prediction of failure. Because the chance of a successful vaginal delivery is > 60% in women with a prediction of failure, until a selection criterion with a better prognostic value can be identified, a liberal approach to vaginal birth after cesarean section is justified even in this group. A 60% chance is perceived by many women and physicians as too low to elect this option. Since we were able to predict a successful vaginal delivery in a large proportion of the candidates, it may encourage at least this group of patients to elect a trial of labor.

Birth Weight↗
PubMed1993

Neurofibromatosis and pregnancy. An update.

Neurofibromatosis is one of the most frequent genetic diseases in humans. Pregnancy in neurofibromatosis patients is, however, less common. Most current information on pregnancy and neurofibromatosis is derived from case reports, which may not reflect the true situation. In the past 15 years only two series of pregnant neurofibromatosis patients were reported in the English-language literature. We present our experience with 34 pregnancies in nine neurofibromatosis patients who delivered at our medical center. While fertility does not seem to be impaired in neurofibromatosis, these patients experience a higher-than-expected rate of first-trimester spontaneous abortions (20.7%), stillbirths (8.7%) and intrauterine growth retardation (13.0%). A high rate of cesarean section (26%) was also observed in our series. We conclude that pregnant neurofibromatosis patients constitute a high-risk group, in danger of developing life-threatening complications. However, with proper antenatal care, most pregnant neurofibromatosis patients can deliver safety if the pregnancy continues beyond the first trimester.

Adult↗
PubMed1993

Cavernous hemangioma of the uterus in a pregnant woman.

BACKGROUND: Cavernous hemangioma of the uterus is a rare but serious condition, especially during pregnancy. Most reported cases ended with hysterectomy in an attempt to control profuse bleeding, and only one of four resulted in a live birth. We describe the sonographic differential diagnosis of this condition and propose management of these patients. CASE: Cavernous hemangioma of the uterus was diagnosed sonographically at 33 weeks' gestation. Conservative management resulted in a favorable outcome for both mother and child. CONCLUSION: Ultrasound is helpful in the prenatal diagnosis of cavernous hemangioma of the uterus; however, other uterine or placental abnormalities with similar sonographic appearances should be considered in the differential diagnosis.

Adult↗