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Biomedical subjects

S Mashiach

Publications and source records attributed to S Mashiach.

At least 109 records · Page 6Linked to original sources
PubMed1995

Intrauterine growth of triplets as estimated from liveborn birth weight data.

This study was conducted to estimate intrauterine growth of triplet pregnancies from liveborn birth weights. During the years 1975-92, 109 sets of triplets were born at our hospital. Ten sets were excluded because of either major fetal anomalies or fetal death of one or more of the fetuses. The remaining 99 sets of triplets consisted of 297 newborns that were weighted immediately after birth. The mean birth weight was plotted against gestational week. The estimated intrauterine growth of triplets, in contrast to singletons, exhibited neither an acceleration phase during the third trimester, nor a flattening of the growth curve during the last few weeks of the third trimester. The mean birth weight of triplets was slightly below the 10th centile for singletons at 38 weeks' gestation or later. We conclude that the growth of triplet fetuses as estimated from liveborn birth weights is slower than that of singletons. The diagnosis of intrauterine growth retardation in triplet pregnancies should be based on growth curves to be devised for triplet pregnancies.

Bias↗
PubMed1995

Fetal lateral neck cysts: early second-trimester transvaginal diagnosis, natural history and clinical significance.

The objective of the study was to explore the natural history and clinical significance of lateral neck cysts during the early second trimester of pregnancy. A survey was conducted of pregnant women at 12-15 weeks' gestation who presented at the ultrasonographic unit between January 1991 and December 1994. During the 4-year period, of the 1500 fetuses scanned, 42 fetuses with lateral neck cysts were detected by high-resolution transvaginal ultrasonography. Twenty-six of the 42 fetuses were seen to have isolated lateral neck cysts, and 16 demonstrated a combination of nuchal thickness of > or = 4 mm and lateral neck cysts. Natural history, fetal karyotype and pregnancy outcome were compared between these two groups. None of the fetuses with isolated neck cysts had an abnormal karyotype, and all cysts resolved spontaneously at 16-20 weeks. No congenital abnormalities were found among the 26 cases. Four chromosomal abnormalities (three trisomy 21 and one monosomy XO) were detected among the 16 fetuses with combined lesions, resulting in termination of pregnancy in all. Among the remaining 12 fetuses, spontaneous resolution of the neck findings occurred between 16 and 20 weeks' gestation. The finding of isolated lateral neck cysts in the early second trimester is not associated with increased risk of aneuploidy. However, the combination with nuchal thickness of > or = 4 mm should prompt genetic counselling and consideration of karyotyping, since this delay in maturation of the cervical jugular lymphatic communication may be associated with chromosomal aberrations.

Adult↗
PubMed1995

Adjuvant growth hormone therapy in poor responders to in-vitro fertilization: a prospective randomized placebo-controlled double-blind study.

The objective of the study was to assess the effect of growth hormone (GH) supplementation to a combined gonadotrophin-releasing hormone agonist/human menopausal gonadotrophin (GnRHa/HMG) treatment protocol on ovarian response in 'poor responders' undergoing in-vitro fertilization (IVF). GH or a placebo were administered in a prospective randomized double-blind manner. A total of 14 poor-responder patients (oestradiol < 500 pg/ml, less than three oocytes retrieved in two previous IVF cycles) were randomly allocated to a combined treatment of either GnRHa/HMG/GH (18 IU on alternate days, total dose 72 IU) or GnRHa/HMG placebo. No difference was found between the study and control groups in the number of HMG ampoules used, the number of follicles (> 14 mm) and serum oestradiol concentrations on the day of administration of human chorionic gonadotrophin (HCG), the number of oocytes retrieved and fertilized, and the number of embryos transferred. The GH group (n = 7) did not show a better ovulatory response in the study cycles; mean +/- SD serum oestradiol on day of HCG 411 +/- 124 versus 493 +/- 291 pg/ml, aspirated oocytes 2.2 +/- 1.5 versus 1.9 +/- 2.0. Interestingly, when the above results for the placebo group were compared with their previous cycles (serum oestradiol 403 +/- 231 pg/ml; 0.4 +/- 0.5 aspirated oocytes), a non-specific effect was found. Follicular recruitment, oestradiol secretion by mature follicles and the number of oocytes retrieved in poor responders were not improved by GH supplementation.

Adult↗
PubMed1995

Reproductive outcome following hysteroscopic management of intrauterine septum and adhesions.

The reproductive outcome of women with repeated abortions or infertility was assessed following treatment by operative hysteroscopy for an intrauterine septum or adhesions. A prospective follow-up study (mean +/- SD, 21.1 +/- 10.3 months) of 47 patients with an intrauterine septum (36 suffering from infertility and 11 from recurrent abortions) and 36 patients with intrauterine adhesions (24 complaining of infertility and 12 of recurrent abortions) was performed. The pregnancy rate in infertile women following hysteroscopic resection of an intrauterine septum or adhesions was 53 and 48% respectively. The pregnancy wastage in women with recurrent abortions who underwent hysteroscopic resection of an intrauterine septum or adhesions decreased postoperatively from 87.5 to 44.4% and from 86.5 to 42.8% respectively. Our results suggest that hysteroscopic resection of an intrauterine septum or adhesions may benefit patients suffering from infertility or recurrent pregnancy wastage.

Abortion, Habitual↗
PubMed1995

A reappraisal of the feedback effects of oestradiol upon luteinizing hormone surge.

The objective of this study was to assess the temporal relationships of serum oestradiol and luteinizing hormone (LH) with regard to the feedback mechanism leading to the LH surge. Daily measurements of oestradiol, LH and follicle stimulating hormone were made in 65 women with ovarian failure undergoing an evaluation of endometrial response to oral cycle stimulation. Patients received incremental oral oestradiol valerate for varying durations at the in-vitro fertilization unit of the Sheba Medical Center, Tel Hashomer, Israel. The treatment protocol involved the administration of daily oestradiol valerate, starting with 1 mg/day, followed by a daily increment of 1 mg for a total of 4, 6 and 8 days. After the last day, a daily maintenance dose of 2 mg was continued. Serum oestradiol concentrations correlated with the dose of oral oestradiol valerate. Peak oestradiol concentrations (mean +/- SEM) were 572 +/- 60, 721 +/- 42 and 797 +/- 53 pg/ml for 4, 6 and 8 days of oestradiol valerate administration respectively. Serum LH, after an initial suppression, peaked 2 days after maximal oestradiol valerate dose and 1 day after peak serum oestradiol. The magnitude of the LH peak was proportional to the duration of incremental oestradiol valerate treatment. In conclusion, the LH surge is temporally related to the cessation of serum oestradiol increase. Consequently, the occurrence of this surge can be explained by a simple negative feedback inhibition of pituitary LH release rather than by a dual negative/positive mechanism.

Adult↗
PubMed1995

The effect of serum follicular phase luteinizing hormone concentrations in habitual abortion: correlation with results of paternal leukocyte immunization.

A prospective study was carried out on 153 couples with recurrent abortions who desired pregnancy. The object was to determine the incidence of raised luteinizing hormone (LH) levels; to compare the outcome of further pregnancies in habitually aborting women with and without raised circulating LH concentrations; and to assess whether the efficacy of paternal leukocyte immunization is affected in the presence of raised LH concentrations. Of the 153 women with recurrent abortions (> 3) included in this study, 56 (36.6%) had follicular phase serum LH concentrations > 10 mIU/ml. Of the 103 pregnancies that were followed prospectively, 65 (63.1%) resulted in a birth of a live infant. There was no significant relationship between the pregnancy outcome and LH concentrations. Women who underwent immunization with paternal leukocytes had significantly more live births (75.8%) than those who were not immunized (43.6%). However, the live birth rate was lower after paternal leukocyte immunization in the presence of raised LH concentrations or a raised LH/follicle stimulating hormone (FSH) ratio.

Abortion, Habitual↗
PubMed1995

The clinical value of umbilical artery Doppler velocimetry in the management of intrauterine growth-retarded fetuses before 32 weeks' gestation.

The objective of this study was to investigate the clinical utility of umbilical artery Doppler velocimetry in the management of very premature growth-retarded fetuses. The study comprised 34 fetuses between 26 and 34 weeks' gestation, diagnosed ultrasonically as suffering from intrauterine growth retardation. Based on the umbilical artery Doppler findings, patients were divided into 3 groups: group 1 (10 fetuses) with normal Doppler systolic/diastolic (S/D) ratios (within 2 SD of the mean for gestational age); group 2 (9 fetuses) with significant abnormal umbilical artery S/D ratios (above 2 SD of the mean for gestational age), and group 3 (15 fetuses) with absent or reverse end-diastolic flow. Fetal outcome was assessed in terms of neonatal mortality and morbidity, i.e. low umbilical artery pH (pH < 7.20) and Apgar scores. In group 1, all fetuses had a stable, normal S/D ratio; in group 2, 2 fetuses (22%) showed deterioration in the Doppler findings and were transferred to group 3, while in group 3, 3 of 15 fetuses (20%) showed improvement in the absence of end-diastolic flow and were thus transferred to group 2. Emergency cesarean section due to antenatal deterioration of the biophysical profile occurred in only 1 patient (10%) in group 1, compared to 33 and 87% in groups 2 and 3, respectively (p < 0.05). The other 9 patients in group 1 had normal vaginal deliveries at 36-37 weeks' gestation, with no perinatal complications. The mean expectant interval from admission to delivery in group 3 was 8.2 days, while in groups 1 and 2 it was 23.8 and 22.2, respectively (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Fetal pleural effusion: the risk of fetal trisomy.

Our objective was to review the association between fetal pleural effusion (FPE) and fetal aneuploidy. We conducted a retrospective survey of pregnant women who presented to our ultrasonographic unit between 1990 and 1991, and in whom the diagnosis of FPE was reached. All fetuses had karyotype investigation and a complete ultrasonographic search for associated anomalies. Six cases of FPE were identified. Trisomy 21 was found in 2 (33%). The English literature was reviewed and an additional 147 cases with FPE were collected, among them 6 cases of trisomy 21 and 1 of monosomy 45X. In this accumulated series the risk of aneuploidy in a fetus with an incidental finding of FPE was 5.8% (9 of 153), thus warranting a karyotype study.

Adult↗
PubMed1995

Increased amniotic fluid divalent cation concentration in preeclampsia.

Hypocalciuria due to reversibly enhanced tubular calcium reabsorption in preeclampsia has been previously described. As the fetus is exposed in utero to the toxemic environment, its kidney function may be similarly affected. We therefore evaluated the amniotic fluid (AF) concentrations of Ca2+, Mg2+, Zn2+, and Na+ in relation to creatinine in 12 preeclamptic women, 9 pregnant women with chronic hypertension, and 12 control pregnant women. Our data reveal an increased AF Ca2+, Mg2+, and Zn2+ to creatinine ratio in preeclampsia 451 +/- 283; 164 +/- 94; 787 +/- 124 Eq/mol, respectively) as compared with chronic hypertension (256 +/- 141; 94 +/- 46; 504 +/- 124 Eq/mol, respectively), and normal controls (274 +/- 132; 83 +/- 19; 477 +/- 124 Eq/mol, respectively; p < 0.05). Na+ concentration did not vary significantly among the three groups. It is suggested that the higher AF divalent cation concentration in preeclampsia may be due to lower maternal urinary excretion thereby increasing the fetal divalent cation load.

Adult↗
PubMed1995

Induced cardioversion of fetal flutter by artificial rupture of membranes at term.

A term fetus with atrial flutter and no signs of cardiac decompensation is described. A trial of pharmacologic cardioversion was unsuccessful, and induction of labor was initiated. Immediately after artificial rupture of the membranes, spontaneous conversion to normal sinus rhythm occurred. The possible mechanism of the cardioverion and the optional treatments for the term fetus with atrial flutter are discussed.

Adult↗
PubMed1995

Polycystic ovarian syndrome: pregnancy outcome following in vitro fertilization-embryo transfer.

A retrospective study of a series of pregnant patients with polycystic ovarian syndrome following in vitro fertilization-embryo transfer was conducted to assess the outcome after ovarian stimulation by different protocols. Forty-one pregnancies were evaluated in patients with polycystic ovarian syndrome who conceived during in vitro fertilization-embryo transfer using human menopausal gonadotropin alone (17 pregnancies), or combined with gonadotropin releasing hormone analog (24 pregnancies). The demographic data of in vitro fertilization-embryo transfer cycles and pregnancy outcome were compared with the use of Student's t-test, the Mann-Whitney U test and Fisher's exact test, where appropriate. Among the pregnancies that were initiated following treatment, the protocol of the combination of the two was not associated with a higher rate of deliveries. The rate of first-trimester abortions was not statistically different between the two groups. These results suggest that the combined use of gonadotropin releasing hormone agonist and human menopausal gonadotropin in an in vitro fertilization program may not have beneficial effects on pregnancy outcome in patients with polycystic ovarian syndrome.

Adult↗
PubMed1995

Sonohysterography for ultrasonographic evaluation of tamoxifen-associated cystic thickened endometrium.

Most menopausal patients with breast cancer receive tamoxifen therapy. In these patients, TVS may show thickened, irregular cystic endometria. For better visualization of these patients' uterine cavities, we performed transvaginal sonohysterography. During vaginal ultrasonography, sterile saline was introduced by transcervical 8 French Foley catheter into the uterine cavity of 20 women who were referred with tamoxifen-associated cystic thickened endometria. In eight women, transvaginal sonohysterography provided the means to diagnose occult, free-floating endometrial polyps, whereas in 12 women, the fluid contrast augmented the diagnosis of an irregular cystic endometrial-myometrial junction. All 20 patients underwent diagnostic hysteroscopy: eight polyps, none of which were malignant, were confirmed and removed by hysteroscopic resection. Of the remaining 12 patients with an irregular endometrial-myometrial junction, endometrial curettage showed no significant pathologic findings. Transvaginal sonohysterography seems to enhance the differentiation between endometrial polyps that should be resected by operative hysteroscopy and an abnormal endometrial-myometrial junction that may benefit from biopsy sampling only.

Aged↗
PubMed1995

Twin pregnancies complicated by the death of one fetus.

The death of one fetus in a twin pregnancy can affect both the mother and the cotwin. Thirty women with twin pregnancies in whom the death of one fetus was diagnosed during the second half of pregnancy and a matched group of 30 women with uncomplicated twin pregnancies were investigated. The mean gestational age at delivery for the study and control groups was 32.0 +/- 5.0 (mean +/- SD) weeks and 32.8 +/- 3.9, respectively. Twelve pregnancies (40%) were monochorionic. In 15 (50%) the diagnosis was made during active labor. The cesarean delivery rate was higher in the study group than in the control group (18 vs. 11, chi 2 = 5.43, P < .02). The mean neonatal weight was similar in both groups (1,586 +/- 725 g vs. 1,543 +/- 691 g). The subgroup of neonates (n = 15) whose cotwins were diagnosed as dead during labor had higher birth weight as compared to the neonates (n = 15) in whom the diagnosis was made prior to delivery and were managed expectantly (1,829 +/- 859 vs. 1,346 +/- 474 g, P < .01). The week of delivery was similar in both subgroups. Neonatal mortality was 30% and 26.6%, while neonatal morbidity was 26.6% and 21.7%, respectively (NS). All the cases of neonatal mortality were in the subgroup of twins in which the diagnosis of in utero death was made before 32 weeks' gestation. The death of one fetus from a twin pregnancy did not significantly jeopardize maternal health, and the neonatal outcome in the remaining twins was primarily a function of gestational age.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1995

Combined vaginal-abdominal delivery of twins.

All cases of combined vaginal-abdominal deliveries at the Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, over an eight-year period (1984-1991) were reviewed. During this period a total of 38,821 deliveries took place. Of 722 (1.9%) twin deliveries, 354 (48.8%) were by cesarean section; 19 were combined deliveries, including 5% of all twins delivered by cesarean section and 2.6% of all twins delivered. High transverse lie and prolapse of the umbilical cord were the main indications for delivery by cesarean section of the second twin. In order to diminish the number of combined deliveries and to increase obstetric skills and experience, a program or protocol for vaginal twin deliveries is indicated.

Breech Presentation↗
PubMed1994

Congenital bilateral absence of vas deferens in the absence of cystic fibrosis.

The high frequency of mutations in the cystic fibrosis gene in patients with congenital bilateral absence of vas deferens (CBAVD) has raised the question whether all of them have a genital form of cystic fibrosis. We investigated 47 CBAVD patients by ultrasonography, 10 (21%) had renal malformations and 37 (79%) did not. In the former group, no cystic fibrosis mutations were found and sweat chloride concentrations were normal. In the latter group, 18 patients (49%) carried at least one cystic fibrosis mutation and sweat chloride was high in 17 of 26 tested (65%). Our findings suggest that CBAVD patients with renal malformations do not necessarily have cystic fibrosis.

Cystic Fibrosis↗