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Biomedical subjects

S Mashiach

Publications and source records attributed to S Mashiach.

At least 127 records · Page 7Linked to original sources
PubMed1994

Prenatal ultrasonographic diagnosis of fetal cerebral ventriculitis associated with asymptomatic maternal cytomegalovirus infection.

Cytomegalovirus is the most common cause of congenital viral infection. In utero infection is usually suspected in patients with growth-retarded fetuses or when maternal illness precipitates serological investigations. A case is presented where routine ultrasound examination at 30 weeks' gestation in an asymptomatic patient demonstrated mild fetal ventriculomegaly. Transvaginal ultrasound enabled the visualization of intraventricular adhesions and small periventricular cysts. The suspected diagnosis of in utero cytomegalovirus infection was confirmed by the presence of IgM antibodies in fetal blood and subsequently by isolation of the virus from the infant's urine. The presence of mild fetal ventriculomegaly should prompt transvaginal brain imaging.

Adult↗
PubMed1994

Perinatal outcome of triplet pregnancies following assisted reproduction.

PURPOSE: This collaborative work was undertaken to assess perinatal outcome of in vivo conceived triplets to those following in vitro fertilization and assisted reproductive technologies (ART). METHODS: 151 triplets were examined; 56 delivered following ART, 55 following ovulation induction by gonadotropins (GN), 27 following clomiphene citrate (CC), and 13 conceived spontaneously. RESULTS: Mean gestational length of triplets following ART (33.2 wks) was not different from those conceived following GN (33.4 wks) or CC (34.2 wks), but was significantly shorter compared to triplets following spontaneous conception (35.3 wks). Mean fetal birthweight following ART (1743 g) did not differ significantly from that following GN (1683 g) or CC (1863 g) but was significantly lower compared to those delivered after spontaneous conception (1963 g). Although no difference was found in the incidence of low birthweight infants between the groups studied, the incidence of very low birthweight newborns (<1500 g) following ART or GN was significantly higher than following spontaneous conceptions (30.6%, 30.3% vs 10.3%). Differences in perinatal mortality were not significantly different between the groups examined (77.9, 60.6, 111.0, 25.6/1000 for ART, GN, CC, and spontaneous conceptions respectively). CONCLUSION: In conclusion, a similar perinatal outcome was shown for triplets conceived following ART and those following ovulation induction by GN, suggesting that the in vitro conditions as such were not the main contributing factor influencing the clinical outcome but rather the GN treatment. Triplets conceived spontaneously have a better outcome compared to those following ovulation induction or ART in terms of gestational length and birthweight.

Birth Weight↗
PubMed1994

Are multiple cesarean sections safe?

To assess the maternal and neonatal risk associated with high-order cesarean sections, a case-control study was carried out in two university affiliated maternity wards. The outcome of 154 pregnancies of women undergoing cesarean section for the 4th time or more was compared with 148 women sectioned for the 2nd or 3rd time and 132 women of similar age and parity after spontaneous birth. The main outcome measures were maternal operative and postoperative morbidity and neonatal prematurity and its complications, Apgar scores, and the need for intensive care. Women undergoing multiple (> or = 4) cesarean sections had significantly more intra-abdominal adhesions (P < 0.0001) than women sectioned for the 2nd or 3rd time. However, the time interval from incision to delivery and the total duration of operation were similar. The postoperative course was not adversely affected by multiple cesarean sections. A high incidence (16.2%) of preterm cesarean deliveries was noted in the study group. This was due to non-elective repeat cesarean delivery rather than to poor timing of scheduled cesarean sections. The significantly increased (P < 0.05) need for neonatal intensive care was explained by the higher occurrence of prematurity. Low Apgar scores (< or = 7) at 1 and 5 min were significantly (P < 0.01) related to multiple cesarean sections, even after controlling for the effect of gestational age. We conclude that multiple cesarean sections pose little risk for the mother, but may be associated with increased neonatal risk, attributed mainly to preterm non-elective cesarean sections.

Adult↗
PubMed1994

Increased incidence of high-order and singleton conceptions after ovulation induction in winter.

The possible relationship between the season of conception after ovulation induction and high-order multifetal pregnancies, was investigated. From 1975 to 1989, 111 high-order multiple births after ovulation induction were recorded at the Chaim Sheba Medical Center. This group was compared with 142 singleton pregnancies that resulted from induction of ovulation during 1989. Composite monthly cohorts of high-order multifetal pregnancies were constructed for each month of the year, and the probability of such pregnancies was estimated. The period of ovulation induction and the day of presumed conception were noted. A statistically-significant increase in the probability of high-order and singleton conceptions occurred during the winter. Our observation indicates a seasonal pattern in high order and singleton conceptions after ovulation induction.

Adolescent↗
PubMed1994

A prospective comparison of the outcome of triplet pregnancies managed expectantly or by multifetal reduction to twins.

OBJECTIVE: Our aim was to compare the outcome of triplet pregnancies managed expectantly or by multifetal reduction to twins. STUDY DESIGN: From January 1984 through January 1992, 140 triplet gestations were diagnosed before the ninth gestational week. Multifetal pregnancy reduction was performed at the patient's request in 34 women. The remaining 106 triplet pregnancies were managed expectantly. All patients were prospectively followed up and delivered in a single perinatal department. RESULTS: Loss of the entire pregnancy before 25 gestational weeks occurred in 20.7% of the triplet pregnancies managed expectantly as compared with 8.7% in the group with reduction to twins. A successful pregnancy as defined by the discharge home of at least one infant occurred in 88.2% of the group with reduction to twins and 74.5% of the triplets managed expectantly. Fetal reduction to twins was associated with a significantly lower incidence of the following: prematurity (p < 0.001), low-birth-weight infants (p < 0.001), and very-low-birth-weight infants (p < 0.001). Pregnancy complications and neonatal morbidity and mortality were less in the group with reduction to twins. CONCLUSIONS: Multifetal pregnancy reduction of triplet pregnancies to twins resulted in improved pregnancy outcome without an excess loss of the entire pregnancy as compared with the outcome of triplet gestations managed expectantly.

Abortion, Therapeutic↗
PubMed1994

Transient blood oxygen desaturation, hypercapnia, and coagulopathy after operative hysteroscopy with glycine used as the distending medium.

OBJECTIVE: Our purpose was to report transient complications associated with operative hysteroscopy with glycine used as the distending medium. STUDY DESIGN: All the operative hysteroscopies performed over a 6-month period by a single operator were examined. The blood oxygenation and end-tidal carbon dioxide concentrations were monitored in all cases with a pulse oximeter and a capnograph. Blood samples were obtained during the operation and over the next day to determine coagulation functions, sodium levels, and a complete blood cell count. RESULTS: Oxygen desaturation accompanied by a simultaneous increase in blood carbon dioxide levels occurred in six of the 46 patients. In addition, four of these patients were found to have a significant blood coagulopathy. Hyponatremia was observed in only two of the latter patients. CONCLUSION: Patients undergoing transcervical resection of the endometrium or submucous myomectomy must be closely monitored because disturbances in oxygenation and coagulation functions are not rare. The possibility of avoiding these complications by careful control of intrauterine pressure and the absorption of glycine should be further examined.

Adult↗
PubMed1994

Improved results in multifetal pregnancy reduction: a report of 72 cases.

OBJECTIVE: To evaluate pregnancy outcome after either transabdominal or transvaginal multifetal pregnancy reduction. DESIGN: A study of 72 consecutive multifetal pregnancy reductions. SETTING: Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center Tel Hashomer, Israel. PATIENTS: Seventy-two patients with multifetal pregnancies: 2 twins, 27 triplets, 26 quadruplets, 10 quintuplets, 3 sextuplets, 1 septuplet, 2 nontuplets, and one pregnancy with 12 fetuses. INTERVENTION: Multifetal pregnancy reduction was performed at 9 to 13 weeks' gestation by either transabdominal or transvaginal potassium chloride injection. MAIN OUTCOME MEASURES: Early and late complications related to the procedure, outcome of pregnancy, and comparison of two periods. RESULTS: Procedures performed between 1984 and 1989 (36 patients) were associated with a 33.3% pregnancy loss, whereas those performed between 1990 and 1992 (36 patients) were associated with no pregnancy loss. Of the 17 patients with quintuplets or more, 10 (59%) delivered live and healthy newborns. No difference was found when comparing the transabdominal and the transvaginal approaches. CONCLUSIONS: Both transvaginal and transabdominal approaches are comparable. There is a remarkable decrease in pregnancy loss with experience.

Abortion, Therapeutic↗
PubMed1994

Complete failure of fertilization in couples with mechanical infertility: implications for subsequent in vitro fertilization cycles.

OBJECTIVE: To determine whether complete failure of fertilization of oocytes in couples with mechanical infertility during the first IVF cycle indicates a poor prognosis for subsequent IVF cycles. DESIGN: A retrospective study of 172 cycles of IVF in 50 couples with mechanical infertility and complete failure of fertilization during their first IVF trial. SETTING: In vitro fertilization unit of the Sheba Medical Center. PATIENTS: Fifty couples undergoing one to eight cycles of IVF for mechanical infertility. MAIN OUTCOME MEASURE(S): Fertilization rate of retrieved oocytes and pregnancy rate. RESULTS: Of the initial 50 couples, 44 underwent additional IVF cycles, and 43 (97.7%) achieved fertilization during the second or third cycle. Twenty-four patients conceived during the study period as a result of IVF. CONCLUSIONS: Complete failure of fertilization in couples with mechanical infertility does not necessarily persist during subsequent IVF cycles. Therefore, at least two more IVF cycles should be attempted before reverting to other therapeutic options. Complete failure of fertilization during the first cycle of IVF in couples with mechanical infertility is accompanied by a good prognosis for subsequent cycles.

Female↗
PubMed1994

How often should infertile men have intercourse to achieve conception?

OBJECTIVE: To clarify how often infertile men should have intercourse to achieve conception, the effect of sequential ejaculation on total motile sperm counts was investigated. DESIGN: Case-control study. SETTING: Infertility and IVF unit, tertiary care center. PARTICIPANTS: Five hundred seventy-six men who produced two closely spaced sequential ejaculates. MAIN OUTCOME MEASURE: The total motile sperm counts of the second ejaculates were compared with the total motile sperm counts of the first ejaculates. RESULTS: In normospermic men (n = 359), the total motile sperm counts decreased significantly from 93 (18 to 601) (median [minimum to maximum] x 10(6)) in the first ejaculate to 42 (1.2 to 387) in the second ejaculate, produced 24 hours later. In contrast to the normospermic men, in the asthenospermic group (24 hours difference, n = 81) and in both oligospermic groups, (1 to 4 hours difference, n = 27; and 24 hours difference, n = 45), there were no significant changes in the total motile sperm counts (24 [5.9 to 229] versus 30 [0.8 to 150], 6 [0.8 to 18] versus 3.6 [0.1 to 63] and 13 [2.5 to 32] versus 10 [0.1 to 66], respectively). Moreover, in both oligoasthenospermic groups (1 to 4 hours difference, n = 23; and 24 hours difference, n = 41) the total motile sperm counts increased significantly (3.2 [0.6 to 7.9] versus 8 [0.4 to 48] and 4 [0.2 to 13] versus 4 [0.1 to 101], respectively). In all groups, pooling sequential ejaculates significantly increased the total motile sperm counts, over and above that of the first ejaculate, by 49% in the normospermic group, 95% in the asthenospermic group, 67% and 75% in the oligospermic groups (1 to 4 hours and 24 hours difference, respectively), and 233% and 139% in the oligoasthenospermic groups (1 to 4 hours and 24 hours difference, respectively). CONCLUSIONS: Sequential ejaculation may overcome the impaired sperm transport causing low total motile sperm counts observed in some oligospermic and/or asthenospermic men. Most of these infertile men may significantly increase their fertility potential, assessed by the total motile sperm counts, either by pooling sequential ejaculates for IUI, GIFT, and IVF, or by having intercourse every day or even twice a day, at the time of ovulation.

Case-Control Studies↗
PubMed1994

Raz bladder neck suspension in women younger than sixty-five years compared with elderly women: three years' experience.

OBJECTIVE: To verify the efficacy of Raz bladder neck suspension in producing cure of genuine stress incontinence (GSI) in women younger than sixty-five years compared with elderly women, and to find out whether or not elderly patients are more prone to failure with this technique. METHOD: We reviewed our results with this procedure in 67 women younger than sixty-five years (group I) compared with 21 elderly women (group II). Seventeen patients in group I and 4 patients in group II had bladder neck suspension for grade I-II incontinence, and 50 patients in group I and 17 in group II had additional cystocele repair by the four-corner technique. Rectocele repair and vaginal hysterectomy were also performed when indicated. RESULTS: With a mean follow-up period of 18.2 months for group I and 16.8 months for group II, 57 women (85.1%) in group I were completely cured of stress incontinence, 6 (8.9%) had marked improvement, and 4 (6.0%) had recurrence, while in group II, 19 (90.4%) were completely cured, 1 (4.8%) had marked improvement, and 1 (4.8%) had recurrence. Namely, in group I, 94 percent of the patients were either cured or improved, as compared with 95.2 percent in group II (P = 0.6; Fisher's exact test). Postoperative complications were few, and there was no permanent urinary retention. CONCLUSION: We conclude that, in a relatively short-term follow-up, Raz bladder neck suspension is equally successful in curing stress urinary incontinence in young and elderly females.

Adult↗
PubMed1994

Salpingectomy by operative laparoscopy and subsequent reproductive performance.

Between January 1984 and August 1991, 511 cases of extrauterine pregnancies were diagnosed by laparoscopy in our department. In 374 cases salpingectomy was performed: 184 by explorative laparotomy, and 190 by operative laparoscopy. Patients were scheduled for salpingectomy if one or more of the following criteria were fulfilled: (i) a ruptured tube which was surgically unsuitable for conservation; (ii) no interest in future fertility; (iii) tubes with ectopic gestation previously operated on; (iv) a previous tubal pregnancy on the same side, which was treated expectantly. Salpingectomy was performed via operative laparoscopy with bipolar diathermy forceps and laparoscopic scissors. Pregnancy rates, i.e. intra-uterine and repeat extra-uterine, were evaluated. The reproductive performance following salpingectomy did not differ significantly, whether by laparotomy or laparoscopy: the intra-uterine pregnancy rate was 78 and 64%, respectively and the repeat ectopic pregnancy rate was 12 and 6%, respectively. Salpingectomy via laparoscopy can be performed safely with a low incidence of complications, with subsequent reproductive performance comparable to laparotomy.

Adult↗
PubMed1994

Should lysis of adhesions be performed when in-vitro fertilization and embryo transfer are available?

This study was undertaken to report the results of microsurgical lysis of peri-adnexal adhesions and identify the patients who should be offered surgery and those who should be treated by in-vitro fertilization (IVF). In all, 19 women had filmy adhesions and 32 had dense adhesions; 68.4% of women with filmy adhesions conceived compared with 34.4% of women with dense adhesions (P = 0.02). In patients with filmy adhesions, the cumulative pregnancy rate 2 years after operation (47%) is similar to that reported after five cycles of IVF (52%), leading us to conclude that such patients should be offered surgery first. Dense adhesions are best treated by IVF. Lysis of filmy adhesions produces a similar intra-uterine pregnancy rate whether performed by laparotomy (57.9%) or laparoscopy (56.6%). As operative laparoscopy offers the greatest patient comfort, it is the treatment of choice in these patients.

Adnexal Diseases↗