-
[show abstract]
[hide abstract]
ABSTRACT: Objectives- The purpose of this study was to examine the feasibility of sonographically identifying, measuring, and constructing nomograms of the fetal petrous bone, the part of the temporal bone that houses the auditory apparatus. Methods- A total of 248 consecutive pregnant women between 14 and 40 weeks' gestation were included. During a routine scan using transvaginal or transabdominal sonography, the fetal head was assessed in transverse sections. First, the parotid gland or external ear was identified, followed by the petrous bone. This annular echogenic structure, located medially and superior to the parotid gland or external ear, was measured at its largest anteroposterior diameter. The petrous bone on at least one side was measured; if both sides were visualized easily, both petrous bones were measured. Results- In 247 fetuses, at least one petrous bone was measured. The petrous bone measurement correlated well with the gestational age (R = 0.908; P < .001), biparietal diameter (R = 0.983; P < .001), and femur length (R = 0.913; P < .001). Conclusions- Depiction of the petrous bone is feasible at all gestational ages and correlates well with the gestational age, biparietal diameter, and femur length. The usefulness of the ability to depict this bone in prenatal diagnosis of congenital malformations of the inner ear should be tested in prospective studies.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2013; 32(6):989-993. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The rate of attempted vaginal birth after cesarean has decreased during the past 15 years. Most of the change since the mid 1990s is the result of increasing reports of uterine rupture during trial of labor, with the highest rates related to labor induction. Not all induction agents have the same magnitude of increased risk of uterine rupture, and there have been only a small number of randomized controlled trials of labor induction in women with previous cesarean delivery. Evaluation of the evidence on specific methods of induction reveals that the lowest rate of uterine rupture occurs with oxytocin at 1.1% (95% confidence interval [CI], 0.9%-1.5%) then dinoprostone at 2% (95% CI, 1.1%-3.5%), and the highest rate is with misoprostol, 6% (95% CI, 0.74%-51.4%). We review the incidence of uterine rupture during induction of labor after previous cesarean and examine the methods of induction and the safety of different techniques for cervical ripening, induction, and/or augmentation of labor in women with previous cesarean delivery.
Obstetrical & gynecological survey 11/2012; 67(11):734-745. · 3.10 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine whether gestational sac volume (GSV) or amniotic sac volume (ASV) and/or the difference between them can predict abortion in women with first-trimester threatened abortion.
Ninety patients between 6 and 12 weeks of gestation presenting with vaginal bleeding were studied. Seventy-six delivered after 24 weeks of gestation (group A) and 14 aborted before 20 weeks of gestation (group B). All patients had a singleton viable pregnancy demonstrated by transvaginal ultrasound. Gestational sac and amniotic sac volumes were measured in all the patients using three-dimensional transvaginal ultrasound with Virtual Organ Computer-aided Analysis software, and the gestational sac volume - amniotic sac volume (GSV - ASV) was calculated.
The groups did not differ in terms of age, parity, number of previous abortions, or term deliveries. The GSV (group A: mean 32.0 ± 27.7 cm(3) ; group B: 26.7 ± 29.1 cm(3) ) and the ASV (group A: 21.1 ± 25.5 cm(3) ; group B: 20.6 ± 26.0 cm(3) ) were not statistically different, while the GSV - ASV was significantly smaller in group B (aborting before week 20) (group A: 10.9 ± 10.9 cm(3) ; group B: 6.1 ± 8.6 cm(3) ; p < 0.05). Using receiver operator curves, the area under the curve for predicting normal pregnancy outcome of the GSV - ASV measurement was 0.654. When the GSV - ASV was 1.8 cm(3) or less, abortion was predicted with 84% sensitivity and 43% specificity.
The measurement of the GSV and the ASV are not good predictors of abortion in patients with first-trimester vaginal bleeding, whereas the use of the GSV - ASV may be helpful in predicting the outcome of pregnancy.
Journal of Clinical Ultrasound 07/2012; 40(7):389-93. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess three-dimensional placental volume measurement and three-dimensional power Doppler (3D-PD) indices between 10 weeks and 6 days and 13 weeks and 6 days in predicting pregnancy-induced hypertension (PIH) and small for gestational age (SGA).
Three hundred and eight women undergoing fetal nuchal translucency measurement were prospectively assessed using three-dimensional ultrasound in order to measure placental volume and 3D-PD indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI), using the VOCAL software. The outcome was scored as normal, PIH, SGA or both.
Eight women developed PIH and ten delivered SGA; and 17 developed PIH or SGA. The age, gestational age at the examination or delivery, number of the pregnancy and the nuchal translucency, were similar in all groups. The placental volume, FI and VFI were similar between the groups. The VI was significantly lower when PIH developed (7.86 ± 3.92 vs. 12.02 ± 7.09 in the normal group, P = 0.035). The crown-rump length (CRL) was significantly smaller in the group where either PIH or SGA developed compared to normal outcome (54.29 ± 6.50 and 59.04 ± 8.89, respectively, P = 0.02).
Placental volume is not appropriate for early prediction of PIH or SGA, whereas the VI may be of some potential in detection of PIH. The significance of small CRL in these patients should be further tested.
Prenatal Diagnosis 01/2011; 31(4):367-71. · 2.11 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Previous pregnancies may influence the success of medical termination of pregnancy.
To determine the effect of parity and gravidity on the successful termination of pregnancy using mifepristone and misoprostol.
The medical files of all patients attending a department of obstetrics and gynecology during the years 2006 and 2007 for the purpose of medical termination of pregnancy at < or = 49 days of gestation were analyze retrospectively. The medical history, previous pregnancies and deliveries were recorded. Mifepristone was administered orally followed by 400 mg of misoprostol 48 hours later. A second dose of misoprostol was offered 2 weeks later if uterine content thickness was more than 15 mm. Then, after 24 hours, if uterine content thickness was more than 15 mm the uterus was evacuated by dilation and curettage.
Of 403 women, 349 (86.6%) aborted following the basic regime; 207 (51.4%) (group A) were primiparous while 196 (48.6%) (group B) had at least one prior pregnancy. Uterine curettage was performed in 17 patients (8.2%) in group A and in 37 (18.9%) in group B (P = 0.002). When patients with a history of a previous abortion were excluded from group B, 32 of 143 (22.4%) required curettage (P < 0.001). When patients without a history of previous cesarean section were excluded, 10 of 52 (19.2%) underwent curettage (P = 0.038).
Previous pregnancies negatively affect the success of medical termination of pregnancy, especially in women with a previous term pregnancy. This information is important when counseling women about the method of pregnancy termination.
The Israel Medical Association journal: IMAJ 10/2010; 12(10):606-8. · 1.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To compare gestational sac (GS) volume (GSV) between normal pregnancies and missed abortions and anembryonic pregnancies and to determine at what gestational age differences in GS volume become evident. METHODS.: GSV in missed abortion and anembryonic pregnancy were measured using three-dimensional ultrasound and the results were compared with GSV in normal pregnancies. Pregnancies between 6 and 12(+6) gestational weeks of age according to last menstrual period were included in normal pregnancies, missed abortions, and anembryonic pregnancies.
There were 141 normal pregnancies and 82 missed or anembryonic abortions. GSV was significantly larger in normal pregnancies than in missed or anembryonic abortion: 27.51 + or - 25.25 cm(3) and 8.04 + or - 10.54 cm(3), respectively (p < 0.001). When stratified by weeks, statistically significant differences were found beginning at 7 weeks, while GSV measurements were not significantly different between the normal and abnormal pregnancies from 6 to 6(+6) weeks.
GSV in missed abortion and anembryonic pregnancies is significantly smaller than in normal pregnancies, starting at 7 weeks of gestational age. This finding may be helpful in the diagnosis of missed abortion or anembryonic pregnancies in selected cases.
Journal of Clinical Ultrasound 09/2010; 38(7):367-71. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The results of medical treatment for early pregnancy failure are conflicting.
To determine whether gestational sac volume measurement as well as other variables can predict the success rate of medical treatment for early pregnancy failure.
The study group comprised 81 women diagnosed with missed abortion or anembryonic pregnancy who consented to medical treatment. Demographic data were collected and beta-human chorionic gonadotropin level was documented. Crown-rump length and the sac volume were measured using transvaginal ultrasound. TVU was performed 12-24 hours after intravaginal administration of 800 micro g misoprostol. If the thickness of the uterine cavity was less than 30 mm, the women were discharged. If the sac was still intact or the thickness of the uterine cavity exceeded 30 mm, they were offered an additional dosage of intravaginal misoprostol or surgical uterine evacuation.
Medical treatment successfully terminated 32 pregnancies (39.5%), 30 after one dose of misoprostol and 2 after two doses (group A); 49 underwent surgical evacuation (group B), 47 following one dose of misoprostol and 2 following two doses. There were no significant differences between the groups in age and gestational week. Gestational sac volume did not differ between groups A and B (10.03 and 11.98 ml respectively, P = 0.283). Parity (0.87 and 1.43, P = 0.015), previous pregnancies (2.38 and 2.88, P = 0.037), and betahCG concentration (6961 and 28,748 mlU, P = 0.013) differed significantly between the groups.
Gestational sac volume is not a predictor of successful medical treatment for early pregnancy failure. Previous pregnancies and deliveries and higher betahCG concentration negatively affect the success rate of medical treatment.
The Israel Medical Association journal: IMAJ 06/2010; 12(6):325-8. · 1.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The incidence of abnormal placental invasion has increased 10-fold in the past 50 years, reflecting the increased number of cesarean sections performed. Management relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric hemorrhage at delivery. Women at risk should plan to deliver at an institution with appropriate expertise and resources for managing this condition. We report a case of placenta increta management comprising preoperative placement of a pelvic artery balloon catheter, prophylactic balloon occlusion after delivery of the fetus, and embolization-assisted resection of the invaded uterine wall. We review incidence, methods of prenatal diagnosis, risk factors, and management of abnormally invasive placenta.
Obstetrical & gynecological survey 12/2009; 64(12):811-22. · 3.10 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The majority of post-partum women suffer from pain after vaginal delivery, more so after cesarean section. In most cases, pain management is needed during the post-partum hospitalization period. In Israel there is no national protocol of post-partum pain management.
Presentation of the current status of post-partum pain management used in Israeli hospital maternity departments as a basis for a national protocol of postpartum pain management.
During the months of July and August 2008, Israeli maternity departments were surveyed by telephone interviews regarding their pain management protocols for post-vaginal deliveries and caesarean sections for both breastfeeding and non-breastfeeding mothers.
Treatment protocols were received from 26 maternity departments. All use paracetamol per-os alone or combined with another drug. Dipyrone is used in 22/26 departments, despite the fact that this medication is not approved for use during Lactation. In 15/26 departments, dictofenac is used mostly after caesarean sections. In nine departments, ibuprofen is used post-partum, and tramadol is used in seven. In 20/26 departments surveyed, opioids are used after cesarean section, mostly morphine or pethidine. Methadone is used after caesarean section in two departments.
Post-partum pain management treatment in Israelis not standardized, especially for Lactating mothers and women after caesarean sections. Lactating mothers should be started on paracetamol or ibuprofen per-os, as first-line postpartum pain management treatment. If this is not effective, second line treatment can be short-term morphine, codeine or propoxyphene. These medications are safer than acetylsalicylic acid, dipyrone or pethidine for lactating mothers.
Harefuah 07/2009; 148(7):427-431, 477, 476.
-
[show abstract]
[hide abstract]
ABSTRACT: The cause of vestibulitis, currently known as vestibulodynia, is still an enigma. Among those attempting to decipher the puzzle, Israeli researchers are well represented. This article reviews the developments in terminology, etiology, treatment, and research directions, with an emphasis on the role of IsraeLi research. Forty-four articles, covering a range of aspects of vestibulodynia, are testimony to the commendable contribution of Israeli research to the understanding of this disease. For example, the finding of mast cell proLiferation and degranulation, enhanced heparanase expression, and the resultant increase and penetration of nerve fibers into the epithelial emanates from Israel. Furthermore, an Israeli first proposed the new name, vestibulodynia. Implemented in the 1980s, immediately after its initiation in the United States, surgical treatment and research in Israel is at the forefront in the world. Israeli teams investigating the effectiveness of surgical treatment conclude that perineoplasty is more successful than any other treatment. Nonetheless, with 57% complete response, and 89% improvement, surgery does not cure all those suffering from vestibulodynia.
Harefuah 07/2009; 148(7):465-70, 474, 473.
-
[show abstract]
[hide abstract]
ABSTRACT: To measure and determine normal values of the fetal eyeball volume between 14 and 40 weeks of gestation.
The volume of the fetal eyeball was measured with three-dimensional ultrasound between 14 and 40 weeks of gestation using the VOCAL software.Only singleton pregnancies without fetal growth restriction, diabetes mellitus, hypertension or major fetal malformation were included.
Over all, 203 women were studied. In 125 both eyeballs were measured while in 78 only one eyeball was measured. The volume of the eyeball correlated strongly with gestational age (right: R = 0.946, P < 0.001, n = 171. left: R = 0.945, P < 0.001, n = 156), and with the biparietal diameter (BPD) (right: R = 0.949, P < 0.001, n = 171. left: R = 0.953, P < 0.001, n = 156). Using regression analysis the best correlation between eyeball volume and the BPD were: square of right eyeball = -0.180 + 0.187 BPD, square of left eyeball = -0.182 + 0.187 BPD.
The volume of the eyeball has strong positive correlations with gestational age and BPD. Our data may be helpful in fetuses suspected of having eye anomalies.
Prenatal Diagnosis 05/2009; 29(8):749-52. · 2.11 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although sonographic fetal sex determination is feasible in most pregnancies, in some cases, it may pose difficulties. An attempt to determine the fetal sex should not be made before 12-weeks' gestation because this early, it is relatively inaccurate. After 13 weeks, it is accurate in 99% to 100% of cases without malformed external genitalia. Sonographic fetal sex determination in the late second trimester is based on direct visualization of the external genitalia, whereas in the late first and early second trimester, it is based mainly on the direction of the genital tubercle (the "sagittal sign"): downward direction of the genital tubercle indicates a female fetus and upward direction a male fetus. Other sonographic landmarks, such as the fetal scrotum, the midline raphe of the penis, the labial lines, the uterus, the descended testis, and the direction and origin of the fetal micturition jet in males may contribute to the correct determination of fetal sex. Inaccurate fetal sex determination may occur when the external genitalia are malformed. Three-dimensional ultrasound, although of generally limited diagnostic value for fetal sex determination, may aid in better definition of congenital malformations of the external genitalia.
Obstetrical & gynecological survey 01/2009; 64(1):50-7. · 3.10 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Screening for Group B streptococcus (GBS) in pregnant women is controversial in Israel.
To investigate cases of neonatal sepsis due to GBS in Western Galilee Hospital Nahariya.
We retrospectively evaluated 70,589 live births from 1996 to 2007.
The number of cases of neonatal sepsis preceded by GBS bacteremia was 26, an incidence rate of 0.37/1000 live births. Of the newborns, 16 were male and 10 female. The median gestational age was 38 weeks (range: 25-42 weeks, STD: 3.27 weeks). The median birth weight was 2945 grams (range: 750-4000 grams, STD: 683 grams). Three of the newborns also had GBS in a CSF culture. Early onset GBS sepsis presented in 23 of the newborns (88%), compared to late onset in 3 (12%). Seventeen were Arabs (65%) and 9 Jews (35%). Three of the newborns, all females, died. One was with gestational age of 25 weeks and birth weight 750 grams. A second, with gestational age of 37 weeks, and birth weight 2945 grams, died from pneumonia and septic shock. The third, with gestational age 38 weeks and birth weight 2460 grams, died of meningitis and septic shock. Vaginal and rectal smears of mothers of the latter two newborns were negative for GBS at 30 weeks gestation.
Although the morbidity rate due to neonatal GBS sepsis is lower in the Western Galilee, Israel than in the U.S.A., the current policy in Israel of treating pregnant women at risk for GBS does not seem sufficient. General screening of pregnant women at 35-37 weeks of gestation should be considered.
Harefuah 11/2008; 147(10):770-3, 839.
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the ability of a testing panty liner (TPL) embedded with a pH/ammonia indicator polymer to differentiate amniotic fluid leakage from urine. A multicenter, open-label study in which 339 pregnant women (age 18 to 45 years, minimum 16 weeks' gestation, presenting with unexplained vaginal wetness) were enrolled. The TPL was worn and the results read by the subject and a health care provider (HCP) who was blinded to the subject's reading. Results were compared with the standard clinical diagnosis, as determined by direct visualization of vaginal pooling, crystallization (ferning), and nitrazine tests, performed by a second blinded HCP. Subject experience with the test was assessed with a brief questionnaire. The TPL accurately detected 154 of the 161 subjects found to have amniotic fluid leakage by the standard diagnosis; thus, the sensitivity of the TPL was 95.65%. The specificity was 84.46% (% true negative readings), as the TPL demonstrated a negative result for 125 of the 148 subjects whose clinical diagnosis was negative for amniotic fluid leakage. The overall agreement between the TPL readings of the clinician and that of the subject was 97.40%. The TPL is a reliable test to determine the presence of amniotic fluid leakage.
American Journal of Perinatology 11/2008; 26(1):45-50. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We noted that several patients presenting with both localized vulvodynia (vulvar vestibulitis) and peptic symptoms reported a resolution of dyspareunia after receiving a full treatment course for Helicobacter pylori.
Women with localized vulvodynia were interviewed regarding symptoms of peptic disease. Those with peptic symptoms underwent a blood test for the presence of antibodies to H. pylori and were referred to a gastroenterology consultation. In all women, vestibular biopsies were obtained and stained for H. pylori. Healthy vestibular tissues as well as archival negative and positive gastric tissues served as controls.
Of the blood antibody tests, 12 (80%) were positive. None of the patients had evidence of H. pylori in the vestibule. Eleven women received triple therapy for eradication of H. pylori. Eight (73%) reported complete relief of dyspareunia and of gastric symptoms.
Our study found no immunohistochemical evidence of H. pylori infection in the vestibule but suggested a possible role for anti-H. pylori treatment in localized vulvodynia.
Gynecologic and Obstetric Investigation 07/2008; 66(3):152-6. · 1.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The rates of rehospitalization after cesarean section (1.41%) are significantly higher than those following spontaneous vaginal delivery (0.33%), mainly due to infection following cesarean section and late bleeding after vaginal delivery.
Archives of Gynecology and Obstetrics 06/2008; 277(5):401-4. · 1.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Female fetal sex was assigned based on downward direction of the genital tubercle at 14 weeks' gestation. Subsequently, amniocentesis performed due to the finding of an echogenic focus in the left ventricle revealed a male karyotype. Sonographic examination at 22 weeks' gestation revealed a markedly curved penile shaft. Power Doppler at that time demonstrated a urine jet emanating from the penile base, verifying the diagnosis of penoscrotal hypospadias. We therefore suggest that female fetal sex assignment should be based on the demonstration of the 2 or 4 parallel lines representing the labial folds and not only upon the demonstration of the downward direction of the genital tubercle.
Journal of Clinical Ultrasound 05/2008; 36(9):581-3. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Recently, we have shown that vestibular hyperinnervation and the presence of 8 or more mast cells in a 10 x 10 microscopic field can be used as diagnostic criteria in localized vulvodynia (vulvar vestibulitis). We have also documented that degranulation of mast cells occurs in these cases. The present study further examines the characteristics of vestibular hyperinnervation and mast cell function in localized vulvodynia to elucidate if the 2 processes-hyperinnervation and mast cell increase and degranulation-are related. We examined vestibular tissue from 7 women aged 18 to 48 with severe localized vulvodynia and from 7 healthy control women. Parallel sections were stained by Giemsa and then immunostained for CD117 and heparanase. Nerve fibers that expressed protein gene product 9.5 were examined. Tissues from women with localized vulvodynia documented a significant increase in vestibular mast cells, subepithelial heparanase activity, and intraepithelial hyperinnervation compared with healthy women. This is the first documentation of heparanase activity in localized vulvodynia. Heparanase, which is degranulated from mast cells, is capable of degrading the vestibular stroma and epithelial basement membrane, thus permitting stromal proliferation and intraepithelial extension of nerve fibers, as seen in the present study. The hyperinnervation has been thought to cause the vestibular hyperesthesia distinctive of localized vulvodynia.
International Journal of Gynecological Pathology 02/2008; 27(1):136-41. · 1.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Water intoxication, a form of acute hyponatremia, has been described in various clinical situations. Although hyponatremia is a common metabolic disorder in hospitalized patients, it is generally not well known as a hazard in the labor and delivery room. However, several factors predispose laboring women to develop hyponatremia. Moreover, because the fetus acquires water from the maternal circulation via the placenta, and there is a close correlation between maternal and cord blood serum sodium levels, the newborn infant of a hyponatremic mother is also at considerable risk of developing water intoxication. We review the epidemiology, pathophysiology, clinical features, and treatment of this hazardous disorder. We emphasize the need for awareness of this condition, and call attention to the risk of fluid overload during labor.
Obstetrical and Gynecological Survey 12/2007; 62(11):731-8. · 2.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Offspring exposed to pre-eclampsia in utero had higher systolic blood pressure, and were more obese during adolescence. We hypothesized that metabolic changes, a marker of cardiovascular disease, may be affected by intrauterine exposure to pre-eclampsia.
Blood samples were collected from cord blood of 36 newborns who were exposed to pre-eclampsia in utero and their mothers, and of 35 newborns and their mothers with noncomplicated pregnancies. Serum levels of lipids, homocysteine, and fibrinogen were determined in all samples.
Fetuses exposed to pre-eclampsia in utero had lower birth weight, smaller abdominal circumference (p<0.002; p<0.03 respectively) and higher levels of low-density lipoprotein, homocysteine, and fibrinogen (p<0.01; p<0.001; p<0.001, respectively), compared with fetuses of normotensive, pregnancies. A significant correlation existed between maternal homocysteine concentration and that of newborn infants (r=0.539; p<0.001) and between maternal low-density lipoprotein and newborn homocysteine (r=0.36; p<0.03). Significant negative correlations were found between abdominal circumference of newborns and cord blood concentration of fibrinogen (r= - 0.52; p<0.001) and low-density lipoprotein (r= - 0.42; p<0.001). Maternal plasma homocysteine, low-density lipoprotein, and triglyceride were significantly higher, while high-density lipoprotein was significantly lower in pregnancies with pre-eclampsia as compared with the uncomplicated pregnancy group (p<0.001 for all). Cord blood level of low-density lipoprotein and fibrinogen were best predicted by abdominal circumference of newborn, though maternal level of homocysteine was the most powerful independent predictor of cord homocysteine.
Intrauterine exposure to pre-eclampsia was associated with untoward effects on biochemical risk factor markers for cardiovascular disease. Our findings suggest that the cardiovascular risk of newborns of pre-eclamptic mothers may begin in utero.
Acta Obstetricia Et Gynecologica Scandinavica 01/2006; 85(10):1172-8. · 1.77 Impact Factor
