M P David

Tel Aviv Sourasky Medical Center, Tell Afif, Tel Aviv, Israel

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Publications (128)247.03 Total impact

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    ABSTRACT: The study prospectively evaluated the relationship between sexual dysfunction and urodynamic diagnoses in 100 consecutive female patients referred for urogynecologic evaluation. Sexual function was evaluated by a detailed questionnaire that addressed four phases of the sexual cycle: desire, arousal, orgasm and satisfaction. Each phase of the sexual cycle was assessed separately using a score of 1-4. Total sexual function (TSF) score was calculated by combining the scores of the four examined parameters (range 4-16). Analysis revealed statistically significant (P < 0.05) lower TSF scores in patients with detrusor instability (DI) than in those with genuine stress incontinence, sensory urge or mixed urodynamic diagnoses (8.65 +/- 4 versus 12.22 + 3.6, 10.25 +/- 4.1 and 11.47 +/- 4.1, respectively). Three per cent of the elderly women (>60 years) compared to 29% of the younger women (< or = 60 years) reported urinary incontinence during sexual activity. Sexual function should therefore be routinely evaluated in women presenting with urinary symptoms.
    No preview · Article · Aug 1999 · International Urogynecology Journal
  • D Luxman · JR Cohen · B Almog · R Kedar · A Szold · JB Lessing · MP David

    No preview · Article · Aug 1999 · The Journal of the American Association of Gynecologic Laparoscopists
  • A Groutz · G Fait · J B Lessing · M P David · I Wolman · A Jaffa · D Gordon
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    ABSTRACT: Anal incontinence in young women may be the result of injury to the pelvic floor during vaginal delivery. This study was conducted to evaluate the relationship between obstetric risk factors and the prevalence of anal incontinence 3 months and 1 year after delivery. Three hundred consecutive women who delivered in the obstetric ward of the Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, were prospectively interviewed 3 months postpartum with regard to the symptom of anal incontinence. Patients with anal incontinence that started after delivery were questioned about the type, frequency, and severity of the problem, concomitant stress urinary incontinence (SUI), previous colorectal assessment, and wish for further evaluation and treatment. Obstetric data were collected from the women's medical charts. Symptomatic patients were followed-up 1 year postpartum. Anal incontinence was reported by 21 patients: 19 were incontinent to gas, whereas only 2 patients were incontinent to solid feces (6.3% and 0.7% of the study population, respectively). Five patients (24% of the anal-incontinent patients) also had concomitant SUI. The length of the first and second stages of labor, operative vaginal delivery, and episiotomy were found to be associated (P < 0.05) with the development of anal incontinence at 3 months postpartum. At I year postpartum all patients with combined anal incontinence and SUI had persistent symptoms. The major obstetric risk factors for postpartum anal incontinence are prolonged first and second stages of labor, operative vaginal delivery, and the use of episiotomy.
    No preview · Article · Mar 1999 · Scandinavian Journal of Gastroenterology
  • A Groutz · D Gordon · R Keidar · J B Lessing · I Wolman · M P David · B Chen
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    ABSTRACT: The study was conducted to assess the prevalence of stress urinary incontinence in premenopausal nulliparae, primiparae, and grand multiparae, and to examine possible obstetric risk factors. Three hundred consecutive nulliparae, primiparae, and grand multiparae, 20 to 43 years of age, were interviewed during the third postpartum day of their consequent delivery about the symptom of stress urinary incontinence. Women were asked whether they had experienced stress urinary incontinence before, during, or after previous pregnancies and how troubled they were by their incontinence. Details of general and gynecologic history, parity, mode of previous deliveries, and birth weights were sought. Main outcome measures included prevalence of pregnancy-related and (persistent) nonpregnancy-related stress urinary incontinence. Prevalence of persistent stress urinary incontinence was significantly higher in grand multiparae compared with nulliparae (21% vs. 5%, respectively; P = 0.0008). Prevalence of persistent stress urinary incontinence among grand multiparae who had been delivered of at least one baby weighing more than 4,000 g was significantly higher than in those who did not (29.4% vs. 16.7%, respectively). The birth weight of the first newborn and operative vaginal delivery were not found to be associated with increased risk of stress urinary incontinence. Grand multiparity was found to be associated with an increased risk of developing persistent stress urinary incontinence during reproductive ages. The delivery of at least one baby weighing more than 4,000 g seems to be a predominant factor. Neurourol. Urodynam. 18:419-425, 1999.
    No preview · Article · Feb 1999 · Neurourology and Urodynamics
  • A Groutz · Y Wolf · B Caspi · I Wolman · D Gordon · M P David
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    ABSTRACT: Data concerning medical treatment of interstitial ectopic pregnancies are scarce. These pregnancies are characterized by late and serious clinical manifestations. We report a case of advanced interstitial pregnancy treated successfully by combining methotrexate (MTX) and hysteroscopy. A routine ultrasonic evaluation of a 10-week pregnancy revealed a right interstitial gestational sac 58 mm in diameter and containing an embryo with a crownrump length of 29 mm and embryonic heartbeats. Serum beta-human chorionic gonadatropin (hCG) level was 97,950 mIU/mL. The patient was treated with a systemic MTX/leucovorin regimen. At the end of the one-week course, no embryonic cardiac activity was detected, and a decrease in beta-hCG levels commenced. Persistent trophoblastic tissue, manifested by a low (26 mIU/mL) beta-hCG level in plateau, was successfully removed by way of hysteroscopy. Early detection of interstitial pregnancy may facilitate conservative medical treatment.
    No preview · Article · Sep 1998 · The Journal of reproductive medicine
  • D Luxman · I Wolman · A Groutz · J.R. Cohen · M Lottan · D Pauzner · M.P. David
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    ABSTRACT: This study was undertaken to prospectively evaluate the effect of early administration of epidural bupivacaine (0.25%) on the progression and outcome of labor in 60 nulliparous patients. Patients were randomly divided into two groups. In group 1 (30 patients, early administration), the epidural catheter was sited and the first epidural injection of 0.25% bupivacaine administered at a cervical dilatation of <4 cm; group 2 (30 patients, late administration) received the epidural catheter and first epidural injection of 0.25% bupivacaine at a cervical dilatation of >or=4 cm. The progression and outcome of labor were compared between the two groups. There were no statistically significant differences between the two groups in rate of cervical dilatation, duration of the second stage, numbers of instrumental deliveries or cesarean sections or Apgar scores at 1 and 5 min. We conclude that there is no need to restrict epidural top-ups until cervical dilatation of 4 cm, when active management of labor is advocated.
    No preview · Article · Jul 1998 · International Journal of Obstetric Anesthesia
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    ABSTRACT: The study was conducted to compare the neonatal and maternal outcome of breech infants delivered vaginally at term with those delivered by cesarean section. All singleton term breech deliveries between January 1, 1992 and December 31, 1994 were reviewed (n = 496). Criteria for eligibility for vaginal trial of labor included: frank or complete breech presentation, estimated fetal weight of 2000-3800 g, no hyperextension of the fetal head and no history of uterine scar (group A, n = 283). Patients who did not fulfill these criteria, or had an abnormal pelvimetry, were delivered by cesarean section without a trial of labor (group B, n = 213). In group A, 226 patients (80%) delivered vaginally, and 57 (20%) patients underwent a cesarean section; 70% of the nulliparae and 89% of the multiparae delivered vaginally. No differences were observed between the groups in gestational week, number of nulliparae, pregnancy complications, and rates of epidural analgesia. However, maternal age and birth weight were significantly higher in group B. No maternal or perinatal mortality occurred. The incidences of 5-min Apgar score <7, birth trauma, neonatal complications, and neonatal intensive care unit admissions were similar between the groups and in the nulliparae and multiparae of each group. Maternal morbidity was significantly lower in patients who delivered vaginally. We conclude that a trial of labor in breech presentation based on appropriate selective criteria, and an active policy of labor management performed by experienced physicians, will facilitate safe delivery in most nulliparae and multiparae.
    No preview · Article · Feb 1998 · American Journal of Perinatology

  • No preview · Article · Dec 1997 · Fertility and Sterility
  • A Groutz · D Pauzner · M P David

    No preview · Article · Dec 1997 · Harefuah
  • D Luxman · J Jossiphov · J R Cohen · Y Wolf · M P David
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    ABSTRACT: Malignant melanoma is the second most common vulvar malignancy. The superficial inguinal lymph nodes are the main site of metastases. Endometrial metastasis of vulvar malignant melanoma has not been previously reported. Vulvar malignant melanoma was diagnosed in a 60-year-old, postmenopausal woman. Immunohistochemical stains were positive for vimentin and S-100 protein and negative for HMB-45. Six months following vulvectomy, right inguinal lymphadenectomy and immunotherapy, curettage was performed due to postmenopausal bleeding. Histologic and immunohistochemical examinations revealed metastatic malignant melanoma with the same staining reactivity as the primary vulvar neoplasm had. Hysterectomy and bilateral salpingo-oophorectomy was performed, disclosing invasion of the endometrium and the inner two thirds of the myometrium. Only 10 other cases of endometrial metastases from malignant melanoma have been previously reported. All those cases involved a primary tumor occurring in the trunk and extremities. This is presumably the first report on endometrial and myometrial metastases from vulvar malignant melanoma.
    No preview · Article · May 1997 · The Journal of reproductive medicine
  • I Wolman · J Hartoov · D Pauzner · A Grutz · A Amit · M P David · A J Jaffa
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    ABSTRACT: We prospectively evaluated 29 patients with early postabortion or postpartum bleeding, suspected of having possible retained trophoblastic tissue by transvaginal sonography and transvaginal sonohysterography. All patients received methyl-ergometrine maleate (Sandoz) and amoxicillin and clavulinic acid (Pharmascope) orally for 5 days and were then reevaluated. Ten patients (34.5%) had a normal uterine cavity on both transvaginal sonography and sonohysterography. Nineteen patients (65.5%) were suspected of having residual trophoblastic tissue by transvaginal sonography. Of these, five (26%) showed normal uterine cavity by sonohysterography. One patient (8.3%) reported heavy bleeding with clots after the conservative treatment. Repeated examination revealed normal uterine cavity. The remaining patients underwent curettage, and histopathologic examination revealed trophoblastic tissue. Transvaginal sonohysterography is more accurate than transvaginal sonography for diagnosing residual trophoblastic tissue in patients with postpartum and postabortion bleeding. Its use may eliminate unnecessary curettage procedures.
    No preview · Article · May 1997 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
  • A Groutz · Y Wolf · M P David

    No preview · Article · May 1997 · Harefuah
  • Source
    Y Yaron · A Amit · A Kogosowski · M R Peyser · M P David · J B Lessing
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    ABSTRACT: There has been growing concern about the number of multiple gestations resulting from assisted reproductive technologies. For in-vitro fertilization (IVF), there are guidelines concerning the number of embryos to be transferred. In oocyte donation, however, there is a paucity of studies addressing this issue and common practice is extrapolated from standard IVF procedures. This may not be correct since endometrial receptivity has been shown to be altered in oocyte donation. Thus the purpose of this study was to assess the optimal number of embryos to be transferred in oocyte donation. The study population included 254 patients with ovarian failure who underwent a total of 601 embryo transfers in a single shared oocyte donation programme. Pregnancy rates (PRs), multiple pregnancies, triplet pregnancy rates, and implantation rates were evaluated according to the number of embryos transferred. A significant linear increase in PRs was noted with the increasing number of embryos transferred up to five (11.1% for one embryo, 36.7% for five embryos). Multiple pregnancies increased significantly from 15.8% for two embryos transferred, to 44.4% for five embryos. The rate of triplet pregnancies also increased from 2.7% for three embryos transferred, to 8.3% for five embryos. Optimization of the number of embryos to be transferred is discussed.
    Full-text · Article · May 1997 · Human Reproduction
  • D Luxman · J R Cohen · D Gordon · I Wolman · Y Wolf · M P David
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    ABSTRACT: Severe ovarian hyperstimulation syndrome is a life-threatening complication of ovulation induction. The clinical picture includes ovarian enlargement, accumulation of ascites and pleural effusion, increased coagulability and electrolyte disorders. Accumulation of ascites increases the intraabdominal pressure so that breathing difficulties ensue. Paracentesis is the only treatment that can immediately prevent respiratory deterioration. Nine women with severe ovarian hyperstimulation syndrome were treated by paracentesis for the drainage of massive ascites. Unilateral vulvar edema developed in all cases in which the lower abdomen was the puncturing site. This phenomenon was not observed when paracentesis was carried out through the upper abdomen. The edema resolved spontaneously over the subsequent 10 days. Apparently the puncturing needle created a fistulous tract through which the ascitic fluid was forced, by the increased intraabdominal pressure, into the subcutaneous tissues, presenting as unilateral vulvar edema. This can be prevented by using one of the abdominal hypochondriac regions as the puncturing site. This phenomenon is self-limited and causes only mild discomfort without late sequelae.
    No preview · Article · Nov 1996 · The Journal of reproductive medicine
  • I Wolman · A J Jaffa · J Hartoov · A Bar-Am · M P David
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    ABSTRACT: Sonohysterography is a technique for evaluating the uterine cavity by the instillation of sterile saline solution through an 8 Fr Foley catheter, before performing an ultrasonographic evaluation. The sensitivity and specificity of the procedure were evaluated in comparison to hysteroscopy. In a prospective double-blind study, 47 postmenopausal patients were evaluated first by sonohysterography, and within 1 week by hysteroscopy. After comparing the hysteroscopic and sonohysterographic results, sonohysterography showed a sensitivity of 86% and specificity of 100%. Sonohysterography is an accurate mode of diagnosis for pathologic intrauterine processes in perimenopausal patients.
    No preview · Article · May 1996 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
  • Source
    F Azem · Y Yaron · A Amit · I Yovel · Y Barak · M R Peyser · M P David · J B Lessing

    Full-text · Article · Feb 1996 · Human Reproduction
  • A Amit · Y Yaron · F Azem · M R Peyser · M P David · J B Lessing
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    ABSTRACT: To examine the efficacy of extending ovulation induction for the in vivo maturation of oocytes. Fifty-nine high responders underwent 72 in vitro fertilization (IVF) cycles with a conventional protocol of human menopausal gonadotropin and a gonadotropin-releasing hormone analog. These patients donated oocytes to 81 recipients. The same 59 patients underwent 90 subsequent cycles in which the duration of induction was extended by two to three days. The oocytes were also donated to 138 patients. With the extended protocol, significantly more oocytes were retrieved (29.1 vs. 20.6), and a greater proportion of them were mature. Fertilization rates were significantly higher for both donors (67.7% vs. 36.2%) and recipients (67.5% vs. 47.1%). Conception rates were also significantly higher for both donors (24.4% vs. 11.1%) and recipients (38.4% vs. 24.7%). Extending the duration of ovulation induction in high responders is associated with in vivo maturation of oocytes and improved success rates in IVF and ovum-donation programs.
    No preview · Article · Oct 1995 · The Journal of reproductive medicine
  • MP David · JR Cohen · D Luxman

    No preview · Article · Aug 1995 · The Journal of the American Association of Gynecologic Laparoscopists
  • D Luxman · JR Cohen · MP David

    No preview · Article · Aug 1995 · The Journal of the American Association of Gynecologic Laparoscopists
  • JR Cohen · D Luxman · MP David

    No preview · Article · Aug 1995 · The Journal of the American Association of Gynecologic Laparoscopists

Publication Stats

1k Citations
247.03 Total Impact Points


  • 1984-1999
    • Tel Aviv Sourasky Medical Center
      • • Obstetrics Gynecology
      • • Intensive Care Unit
      Tell Afif, Tel Aviv, Israel
  • 1969-1998
    • Tel Aviv University
      • • Department of Obstetrics and Gynecology
      • • Sackler Faculty of Medicine
      Tell Afif, Tel Aviv, Israel
  • 1989-1994
    • Assaf Harofeh Medical Center
      Ayun Kara, Central District, Israel