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Biomedical subjects

R Frydman

Publications and source records attributed to R Frydman.

At least 397 records · Page 22Linked to original sources
PubMed1978

[Perforation of the uterus after voluntary termination of pregnancy using the aspiration technique. Two serious cases (author's transl)].

The authors formulate some safety rules in view of two case histories of bowel complications following voluntary termination of pregnancy using suction techniques. Where it is not certain that a perforation has occurred laparoscopy is necessary. When perforation has been confirmed a laparotomy is undertaken in order to check the state of the bowel throughout its length, because when lesions of the digestive tract are treated rapidly the results are good whereas when they have to be treated for peritonitis the outlook is poor.

Abortion, Induced↗
PubMed1977

[Intrauterine growth retardation and prenatal nutrition. II. Personal cases].

We have carried out an enquiry into feeding in mothers in whom failure of intra-uterine growth of the fetus has been suspected around the thirtieth week of amenorrhoea according to clinical criteria (23 cases with a mean birth weight of 2564 g). We used a special questionnaire in the third trimester of pregnancy. The special feature of these failures of intra-uterine growth were that they did not appear to have any known cause. The calory intake of the mother was compared at the same time with a control group (39 cases where the mean birth weight was 3333 g). A significant difference was found in the calory intake (2241 Kcal as against 2553 Kcal) and this was especially connected with a low carbohydrate intake. The consequences of this deficiency in maternal carbohydrates on the birth weights of the newborn is discussed taking into account other factors that could interfere with fetal growth.

Birth Weight↗
PubMed1976

Primary prostaglandins in amniotic fluid in pregnancy and spontaneous labor.

Primary prostaglandins have been measured by radioimmunoassay in the amniotic fluid of 80 patients. In late pregnancy, PGE2 was higher than PGF2alpha with an increase around 36 weeks (378 +/- 71 pg. per milliliter) without significant modification until term. PGF2alpha increased too, but only significantly at term. During spontaneous labor, PGE2 and PGF2alpha were higher than before the onset of labor. Through serial determinations in five patients, two steps can be distinguished: the first one with stable levels but large oscillations of PGE2 and PGF2alpha and the second one starting at a variable stage of cervical dilatation with inversion of PGE2/PGF2alpha ratio (less than 1 and followed by an increase of both compounds more pronounced for PGF2alpha. It appears that PGE2 is concerned with the initiation of parturition while both PG's and mainly PGF2alpha are in relation to the contractions and the duration of labor.

Amniotic Fluid↗
PubMedDate not supplied

[Alternatives to amniocentesis for maternal age].

Screening strategies of Down's syndrome should be re-evaluated. Amniocentesis for advanced maternal age has been proposed in the 70's because no other screening test was available. Maternal serum screening and first trimester nuchal translucency are now well validated, including in women over 38. The sequential and independent use of different screening tests leads to a dramatic increase of the false positive rate and thus of iatrogenic fetal losses. Maternal age remains the major risk factor for chromosomal anomalies, but it should be included in risk calculation strategies (ideally combining serum screening and nuchal translucency), and not taken as an isolated information. These screening strategies require strict quality control and audit, which is currently better achieved with serum screening than ultrasound screening. A complete information about Down's syndrome screening strategies should be given to women, regardless of their age, and their personal choice should be respected. For women of advanced maternal age, a policy of selective rather than routine amniocentesis is likely to reduce the risk of iatrogenic fetal loss and yet to allow for a reasonable sensitivity.

Adult↗
PubMedDate not supplied

GnRH antagonist in single-dose applications.

Previous studies on ovarian stimulation have confirmed the efficacy of a single dose of the gonadotrophin-releasing hormone (GnRH) antagonist, Cetrorelix, in preventing premature LH surges. The single-dose protocol is easy to use and assures patient compliance. When compared with the long protocol using a depot administration of the GnRH agonist, triptorelin, the IVF results in patients treated with Cetrorelix showed a shorter treatment duration, reduced amount of human menopausal gonadotrophin (HMG) required and a lower occurrence of ovarian hyperstimulation syndrome (OHSS). The pregnancy rates did not differ significantly between the two treatments. The use of Cetrorelix in natural cycles associated with gonadotrophins reduced the rate of premature LH surges and, therefore, the cancellation rate. The stimulation was minimal and the preliminary pregnancy rates were satisfactory. If a larger study confirms the results of the natural cycle with HMG support, the single-dose administration of GnRH antagonist could represent an interesting first-choice IVF treatment in selected indications. The tolerance of Cetrorelix was excellent in all patients, with only mild and transitory reactions at the injection site. New GnRH antagonists are already available for clinical use in some countries, and they will certainly change ovarian stimulation protocols. If the pregnancy rates are confirmed, the main advantages of these new compounds are the reduction in side-effects and complications of the stimulation protocol; a clear benefit to the patients.

Drug Administration Schedule↗
PubMedDate not supplied

Perinatal outcome and developmental studies on children born after IVF.

Since the first birth after IVF, many scientific papers have been published on the technical aspects of the IVF procedure, but few studies have addressed the issue of the perinatal outcome of IVF pregnancies and of the children's development and well-being. A high rate of adverse outcome has been demonstrated in a large group of IVF pregnancies. Prematurity, low birth weight and perinatal mortality are higher than in the general population. The majority of these complications are related to multiple births, but they are also found in singleton pregnancies. An analysis of the multiple risk factors involved in these complications is needed. The infertile status of IVF patients clearly plays a role in the risk of adverse outcome. Age and parity may be important factors. The role of IVF itself has not been demonstrated convincingly. The effect of ovarian stimulation deserves further study. Most of the studies published on the follow-up of IVF children are reassuring, but it is clear that these studies are not sufficient to eliminate without doubt any adverse effects on the well-being of IVF children. All IVF pregnancies should be followed with great care, not because they are more precious than spontaneous pregnancies, but because they are exposed to an increased risk of complications. The main problem of IVF remains the high rate of multiple pregnancies, including twins.

Age Factors↗
PubMedDate not supplied

The use of GnRH antagonists in ovarian stimulation.

GnRH antagonists induce a rapid decrease in LH and FSH, preventing and interrupting LH surges. Their properties do not require a desensitization period, and this allows their use in the late follicular phase. GnRH antagonists could replace GnRH agonists in controlled ovarian stimulation without their side-effects and their long desensitization period. Two protocols for assisted reproduction technology (ART) cycles were designed: the single-dose protocol allies simplicity and efficacy, while the multiple-dose protocol is efficient and could reduce monitoring of the cycle, though compliance is mandatory. A review of the available literature on GnRH antagonists in ART cycles is presented, focusing on phase III controlled trials and ART results. Both protocols using GnRH antagonists were associated with the need for a smaller dose of gonadotrophin, a shorter stimulation period and a lower incidence of ovarian hyperstimulation syndrome (OHSS), albeit with statistically comparable pregnancy rates. A trend is observed in all studies showing a lower pregnancy rates in GnRH antagonist cycles as compared with GnRH agonist cycles. The role of the lower number of embryos, and the potential adverse effects of GnRH antagonists on endometrium or follicle must be studied. More cycles using GnRH antagonists are necessary to confirm their equivalent pregnancy rates. There is room for improvement in both protocols with regard to scheduling, antagonist dose level and the timing of its administration. Until further studies have been conducted, luteal support seems to remain mandatory. Perinatal outcome appears similar to that with other stimulation regimens. Triggering of ovulation can be obtained with GnRH agonist for patients at risk of OHSS. With regard to GnRH antagonists, questions remain regarding pregnancy rates, the indications of their use in patients with polycystic ovary syndrome or poor responders, and in ovarian stimulation outside IVF.

Controlled Clinical Trials as Topic↗
PubMedDate not supplied

Efficiency of ultrasound and biochemical markers for Down's syndrome risk screening. A prospective study.

OBJECTIVE: To evaluate the sequential combination of ultrasound screening for fetal aneuploidy at 11-14 weeks with maternal biochemistry at 12-14 and 15-18 weeks of gestation. METHODS: A prospective study including 1,656 women, with a singleton pregnancy booked before 13 weeks of gestation. Nuchal translucency (NT) thickness was measured by transabdominal ultrasound examination. alpha-Fetoprotein, free betahCG and hCG were measured by immunoradiometric (12-14 weeks) or immunometric (15-18 weeks) assays. Derived risks were then calculated. Cutoff risks were chosen first arbitrarily at 1/250 and then adjusted for a 5% false-positive rate. RESULTS: Seven fetal aneuploidies were diagnosed, including 5 Down's syndromes, 1 trisomy 18 and 1 triploidy. Three Down's syndromes had concordant high risk with the 3 screenings. One was at low risk with NT, and another was at low risk by maternal serum screening, but sequential combination of screenings led to a 100% detection rate with cutoffs of 1/240, 1/160 and 1/250 for NT, first- and second-trimester biochemistry, respectively (i.e. for a cutoff adjusted for a 5% false-positive rate). CONCLUSION: This preliminary study suggests a benefit in combining maternal age-related risk together with NT and biochemical markers in the first or the second trimester. The algorithm combining these risks needs to be established in a wide population.

Adolescent↗
PubMedDate not supplied

Is routine amniocentesis for advanced maternal age still indicated?

OBJECTIVE: To evaluate a policy of selective rather than routine use of amniocentesis for advanced maternal age. METHOD: A consecutive series of 359 pregnant women aged 38-47 underwent nuchal translucency measurement (NTM) at 10-14 weeks, maternal serum screening (MSS) by alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) at 15-17 weeks, and second trimester ultrasound at 21-23 weeks. Women with NTM <3 mm, MSS-derived risk <1/250, and a normal second trimester sonography were considered at low risk and were suggested not to have an amniocentesis. RESULTS: Either the NTM or MSS test was positive in 130 women; 105 (81%) of them elected to have an amniocentesis, versus 122 (53%) of 229 in whom both tests were negative (p < 0.001). Nineteen (5%) of 359 patients had NTM > or =3 mm; all 7 cases of Down's syndrome were in this group; 122 (34%) of 359 patients had a MSS-derived risk > or =1/250; 6 of the 7 cases of Down's syndrome were in this group: Ten patients had an abnormal second trimester ultrasound, 1 of which had trisomy 18. Of the 219 patients with MSS-derived risk <1/250, a NTM <3 mm, and a normal second trimester ultrasound, none had a baby with a chromosomal abnormality (95% confidence interval: 0-1.4%). CONCLUSION: Amniocentesis may be offered on a selective rather than routine basis in women over 38, based upon the results of noninvasive screening tests.

Adult↗
PubMedDate not supplied

Pharmacokinetics of interferon-alpha in pregnant women and fetoplacental passage.

Interferon (IFN) therapy is currently not approved for use during pregnancy. Two HIV-seropositive pregnant women, who were due to undergo abortion in the second trimester of pregnancy, were given a single intramuscular dose of IFN-alpha, with their informed consent. Blood samples were taken simultaneously from the mothers and fetuses, together with amniotic fluid. IFN was undetectable in the fetal blood and amniotic fluid in both cases. Pharmacokinetic parameters were similar to those in nonpregnant women. We conclude that maternal IFN-alpha during pregnancy should be safe for the fetus. The indications for IFN therapy in pregnancy could therefore be the same as those in the non-pregnant state.

Abortion, Induced↗
PubMedDate not supplied

Fetal tissue dosages of retinoids. Experimental study concerning a case of isotretinoin (Roaccutan) administration and pregnancy.

The authors report the case of a women who took retinoids (Roaccutan, isotretinoin) during the first trimester of pregnancy, and a therapeutic abortion was carried out. The interest in this case report lies in the determination of the concentration of isotretinoin and its metabolites (4-oxo-isotretinoin, and tretinoin) in fetal tissues, using high performance liquid chromatography. The findings show the significant transplacental crossing of isotretinoin, an accumulation of 4-oxo-isotretinoin in the liver, and a low concentration of retinoids in the brain of this 4-month-old fetus. The authors emphasize that contraception must be used during retinoid treatment, and 4 weeks after retinoids have been stopped.

Abortion, Therapeutic↗
PubMedDate not supplied

Fetal-maternal hydrops syndrome in human parvovirus infection.

A case of maternal generalized edema with hyponatremia, hypoosmolality and secondary hyperaldosteronism was associated with pseudomolar plasma human chorionic gonadotropin (hCG) concentrations in a case of fetal and placental hydrops due to parvovirus B19 infection. Digoxigenin in situ hybridization techniques were effective in demonstrating parvovirus B19 infection on fixed tissues. Hydropic changes in the placenta may have massively increased the maternal plasma hCG concentration with subsequent fluid imbalance leading to maternal hydrops mimicking molar pregnancy.

Chorionic Gonadotropin↗