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Weissman A, Itskovitz-Eldor J, Jakobi P. Sonographic measurement of amniotic fluid volume in the first trimester of pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 1996; 15:771-774. [PMID: 8908588 DOI: 10.7863/jum.1996.15.11.771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The sonographic estimate of amniotic fluid volume from 7 to 13 weeks of gestation in 95 pregnancies was calculated. Amniotic fluid volume increased from 1.5 ml at 7 weeks to 25 ml at 10 weeks and 100 ml at 13 weeks. The nomograms constructed may be used in the objective evaluation of the fetal condition in the first trimester.
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Lurie S, Weissman A, Blumberg G, Hagay Z. Fetal oximetry monitoring: a new wonder or another mirage? Obstet Gynecol Surv 1996; 51:498-502. [PMID: 8832717 DOI: 10.1097/00006254-199608000-00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This review provides recent data and clinical opinions on a new technology in assessing fetal well-being during labor, the fetal pulse oximeter. Fetal pulse oximetry is potentially superior to electronic fetal heart rate monitoring because it allows direct assessment of both fetal oxygen status and fetal tissue perfusion. Several studies during recent years have demonstrated that fetal pulse oximetry during labor is feasible and accurate. On the other hand, these very same studies have demonstrated a few potential disadvantages and limitations of fetal oximetry. The main limitation seems to be a wide range of normal values. The correlation of fetal oximetry during labor with perinatal outcome and long-term newborn outcome has not yet been determined. In summary, fetal pulse oximetry during labor merits further randomized prospective studies, especially with regard to improvement of perinatal outcome.
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Weissman A, Lurie S, Zalel Y, Goldchmit R, Shoham Z. Human chorionic gonadotropin: pharmacokinetics of subcutaneous administration. Gynecol Endocrinol 1996; 10:273-6. [PMID: 8908528 DOI: 10.3109/09513599609012319] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The objective of the present study was to evaluate the pharmacokinetics of human chorionic gonadotropin (hCG) following different regimens of subcutaneous and intramuscular single-dose administration. Two hypogonadotropic hypogonadal volunteers received hCG injections without prior ovarian stimulation. The regimens included a single dose of 10,000 IU hCG either subcutaneously or intramuscularly, or 5000 IU hCG intramuscularly. Serum beta-hCG concentrations were measured periodically up to 13 days after hCG administration. Each of the three regimens exhibit a similar pharmacokinetic profile and the highest serum beta-hCG concentrations were achieved with a dose of 10,000 IU administered subcutaneously. Seven days after hCG administration beta-hCG was detectable only after subcutaneous or intramuscular administration of 10,000 IU, but not after a single intramuscular injection of 5000 IU. From the preliminary results of the study it is suggested that a single intramuscular dose of 5000 IU hCG might be sufficient to trigger ovulation, but for luteal-phase support a higher dose may be needed. Subcutaneous administration of hCG for the induction of ovulation or luteal-phase support in gonadotropin-induced cycles is feasible and might offer a better tolerance and cost-effectiveness of infertility treatments, leading to their further simplification.
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Weissman A, Shoham Z. Doppler and luteal phase defect. Fertil Steril 1996; 66:166-7. [PMID: 8925939 DOI: 10.1016/s0015-0282(16)58411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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105
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Ben-Arie A, Weissman A, Shoham Z. Ovarian hyperstimulation: effects of GnRH analogues. Triggering the final stage of ovulation using gonadotrophin-releasing hormone analogues: effective dose, prevention of ovarian hyperstimulation syndrome and the luteal phase. Hum Reprod 1996; 11:1146-8. [PMID: 8671409 DOI: 10.1093/oxfordjournals.humrep.a019341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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106
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Weissman A, Loumaye E, Shoham Z. Recovery of corpus luteum function after prolonged deprivation from gonadotrophin stimulation. Hum Reprod 1996; 11:943-9. [PMID: 8671368 DOI: 10.1093/oxfordjournals.humrep.a019329] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Three women with hypogonadotrophic hypogonadism, all desiring pregnancy, participated in a prospective open study attempting to assess the ability of the human corpus luteum to recover after 7 days of deprivation from gonadotrophin stimulation. Follicular growth was induced by gonadotrophins. An endogenous luteinizing hormone (LH) surge was induced by the s.c. injection of a gonadotrophin-releasing hormone agonist. For luteal support, 10 mg/day oral medroxyprogesterone acetate were given for 7 days, after which a single i.m. injection of human chorionic gonadotrophin (HCG) was administered. Monitoring during the follicular phase consisted of daily measurements of serum oestradiol, LH and follicle stimulating hormone (FSH) concentrations, and of follicular growth by transvaginal ultrasonography. During the luteal phase, monitoring consisted of measurements of serum concentrations of LH, FSH, oestradiol, progesterone, 17-hydroxyprogesterone and beta-HCG. Ovulation and luteinization occurred in two patients, demonstrated by transient marked increases in serum progesterone and 17-hydroxyprogesterone concentrations which decreased to basal preovulatory values and increased again following the administration of HCG 7 days later. In the third patient, ovulation and luteinization did not occur, and the subsequent administration of HCG did not result in an increase in progesterone concentration. Of the two patients who ovulated, one conceived and the second had a luteal phase of 15 days duration. Our preliminary results suggest that the human corpus luteum can be 'rescued' and can function normally after 7 days of deprivation from gonadotrophin stimulation in patients with hypogonadotrophic hypogonadism.
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Caspi B, Weissman A, Pfefferman R, Appleman Z. Acute appendicitis: diagnosis by transvaginal sonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 1996; 7:359-360. [PMID: 8774103 DOI: 10.1046/j.1469-0705.1996.07050359.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We present a case of a female patient with right lower quadrant abdominal pain, in whom transvaginal ultrasound facilitated the diagnosis of acute appendicitis. The insertion of the appendix into the cecum was demonstrated with direct continuity between the cecal lumen and the appendix. The inflamed appendix was in close proximity to the right ovary and was distinguished by a thick edematous wall and fluid in the lumen. This combination of findings may comprise a new sonographic sign for the diagnosis of acute appendicitis, particularly when performed by transvaginal sonography.
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108
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Hagay Z, Weissman A. Management of diabetic pregnancy complicated by coronary artery disease and neuropathy. Obstet Gynecol Clin North Am 1996; 23:205-20. [PMID: 8684779 DOI: 10.1016/s0889-8545(05)70252-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Various manifestations of diabetic neuropathy may complicate pregnancies of young diabetic patients. Of all forms of diabetic neuropathy, autonomic neuropathy, and, in particular, gastropathy, may cause the most devastating complications. Because neuropathy is a common abnormality in young asymptomatic diabetic women, screening for this disorder may be advisable and can be accomplished by relatively simple and noninvasive tests. Screening is best performed before conception or early in pregnancy, because pregnancy itself and its possible complications later modify the autonomic nervous function tests and make testing unreliable. Practitioners and obstetricians who provide care and counseling to young diabetic patients should be familiar with the risks and consequences to maternal and fetal health that may be imposed by the different forms of neuropathy. Moderate-to-severe autonomic dysfunction may be considered a relative contraindication to pregnancy, especially if gastropathy is part of the clinical presentation. The management dilemmas and high mortality and morbidity associated with symptomatic diabetic neuropathy may justify the addition of a new independent class, class N (neuropathy), to the current classification systems for diabetes in pregnancy.
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Moore PF, Larson DL, Otterness IG, Weissman A, Kadin SB, Sweeney FJ, Eskra JD, Nagahisa A, Sakakibara M, Carty TJ. Tenidap, a structurally novel drug for the treatment of arthritis: antiinflammatory and analgesic properties. Inflamm Res 1996; 45:54-61. [PMID: 8907585 DOI: 10.1007/bf02265116] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Tenidap is a new anti-rheumatic agent which has clinical properties characteristic of a disease modifying drug combined with acute antiinflammatory and analgesic activity. This paper details tenidap's cyclooxygenase (COX) inhibitory activity and the resulting pharmacological properties in experimental animals. Tenidap inhibited calcium ionophore-stimulated prostaglandin D2 synthesis by rat basophilic leukemia cells (COX-1) with an IC50 of 20 nM. In two different in vitro human test systems, tenidap inhibited COX-1 activity more potently than COX-2, although the relative potency ratio (COX-1/COX-2) differed markedly between the two systems. Tenidap inhibited the COX pathway when added to human blood in vitro (IC50, 7.8 mu M) and when administered orally to monkeys, rats and dogs (at 5, 2.5 and 10 mg/kg p.o., respectively) and COX activity measured ex vivo in blood collected 2 to 4 hours post dose. After oral administration to rats, tenidap inhibited carrageenan-induced paw edema with an ED50 of 14 mg/kg and inhibited the glucocorticoid-resistant UV erythema in guinea pigs with an ED50 of 1.4 mg/kg. It retained antiinflammatory activity in adrenalectomized rats indicating that this property is independent of adrenal stimulation. Oral administration of tenidap inhibited the development of adjuvant-induced polyarthritis in the rat and exhibited antinociceptive activity in the murine phenylbenzoquinone and rat acetic acid abdominal constriction tests. These data indicate that tenidap is an effective antiinflammatory and analgesic agent in animal models. These cyclooxygenase-dependent pharmacologic activities do not explain tenidap's disease modifying anti-arthritic properties but add a useful symptom modifying component to its clinical profile.
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110
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Weissman A, Kol S, Peretz BA. Gas embolism in obstetrics and gynecology. A review. THE JOURNAL OF REPRODUCTIVE MEDICINE 1996; 41:103-11. [PMID: 8656409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To review gas embolism in the field of obstetrics and gynecology, with an emphasis on the pathophysiology, clinical presentation and treatment options. STUDY DESIGN A review of the world literature on gas embolism. CONCLUSION Gas embolism is an unusual complication and has increased in frequency since the introduction of new invasive procedures. Since the clinical presentation of gas embolism has many faces, it is important to identify it as early as possible: timely treatment may be life saving, while a delay may have serious consequences.
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111
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Achiron R, Yagel S, Weissman A, Lipitz S, Mashiach S, Goldman B. Fetal lateral neck cysts: early second-trimester transvaginal diagnosis, natural history and clinical significance. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 1995; 6:396-399. [PMID: 8903914 DOI: 10.1046/j.1469-0705.1995.06060396.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
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.
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112
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Weissman A, Hagay Z, Schachter M, Dreazen E. Severe maternal and fetal electrolyte imbalance in pregnancy after gastric surgery for morbid obesity. A case report. THE JOURNAL OF REPRODUCTIVE MEDICINE 1995; 40:813-6. [PMID: 8592320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastric surgery for morbid obesity is considered a safe procedure with favorable effects on reproductive performance. Pregnancies after gastric restrictive operations are usually well tolerated by both mother and fetus. Some postoperative complications, however, do occur, although an association between such complications and adverse pregnancy outcomes has not been reported. CASE A 40-year-old woman had a successful gastric operation for weight reduction but developed chronic, low grade gastro-intestinal obstruction as a late complication of surgery. Subsequent pregnancies ended in late abortion or premature delivery. During her last pregnancy, reported here in detail, severe and life-threatening fetomaternal electrolyte imbalances developed. CONCLUSION Pregnancy following a gastric operation for morbid obesity may be complicated by severe metabolic disturbances that can jeopardize both the pregnant woman and her fetus. These pregnancy complications, which are related to the primary gastric surgery, are reported here for the first time.
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113
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Barash A, Lurie S, Weissman A, Insler V. Comparison of sperm parameters, in vitro fertilization results, and subsequent pregnancy rates using sequential ejaculates, collected two hours apart, from oligoasthenozoospermic men. Fertil Steril 1995; 64:1008-11. [PMID: 7589619 DOI: 10.1016/s0015-0282(16)57920-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the effect of second consecutive ejaculate collected 2 hours after the first one from infertile men on sperm quality and fertilization and pregnancy rates (PRs) in IVF. DESIGN A prospective case-control study. SETTING In vitro fertilization unit of a university hospital. PATIENTS Thirty-nine consecutive infertile patients with oligoasthenozoospermia scheduled for IVF-ET. MAIN OUTCOME MEASURES Two consecutive ejaculates were obtained 2 hours apart and were assessed for volume, sperm count, motility, morphology, and quality of swim-up fraction. The subsequent fertilization, cleavage, and PRs (as defined by the appearance of intrauterine gestational sac) were compared between the two ejaculates. RESULTS In 28.2% of the individuals the semen analysis of the first ejaculate precluded proceeding with IVF. A statistically significant improvement was shown in sperm cell motility (31.9% +/- 20.7% versus 15.6% +/- 15.3%) and in motile count after swim-up (4.9 +/- 4.5 versus 2.6 +/- 3.1 x 10(6) sperm). No improvement could be demonstrated in sperm density or morphology. The volume of the second ejaculate was decreased significantly as compared with the first one. The fertilization rate, the cleavage rate, and PR were all increased when oocytes were exposed to sperm from the second ejaculate compared with oocytes exposed to sperm from the first ejaculate. The overall PR in our series was 25.6%. CONCLUSIONS We suggest that in the group of infertile men with oligoasthenozoospermia, whose partners are scheduled for IVF-ET, if on the day of retrieved oocytes insemination, the ejaculate is of unacceptable quality, a second ejaculate collected 2 hours after collection of the initial ejaculate may produce a sample that exhibits improvements in both semen parameters and reproductive potential.
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Caspi B, Ben-Galim P, Weissman A, Appleman Z. The engorged fallopian tube: a new sonographic sign for adnexal torsion. JOURNAL OF CLINICAL ULTRASOUND : JCU 1995; 23:505-507. [PMID: 7499523 DOI: 10.1002/jcu.1870230809] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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115
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Weissman A, Levy R, Hagay ZJ. The spontaneous resolution of cystic hygroma (CH), hydrops fetalis (HF), and fetal anemia. Am J Perinatol 1995; 12:375. [PMID: 8540947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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116
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Blickstein I, Manor M, Levi R, Goldchmit R, Weissman A. The intrauterine ponderal index in relation to birth weight discordance in twin gestations. Int J Gynaecol Obstet 1995; 50:253-5. [PMID: 8543107 DOI: 10.1016/0020-7292(95)02391-o] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To establish the relationship between the fetal ponderal index and birth weight discordance in twins. METHOD The fetal ponderal index (estimated fetal weight divided by femur length3) was calculated in 86 pairs of twins delivered within 2 weeks of the last sonography and analyzed in relation to birth weight discordance. RESULTS A weak but significant correlation between fetal ponderal index and birth weight (r = 0.26, P < 0.0007) but no correlation with gestational age (r = 0.035, P = 0.65) were found. Members of concordant pairs (< 15% birth weight difference) had a significantly higher fetal ponderal index compared with members of mildly (15-25%) discordant pairs (P < 0.02), but not as compared with members of severely discordant (> 25%) pairs. CONCLUSION The characteristics of the fetal ponderal index in twins are similar to those in singletons. Fetal size seems to be diminished in severe but not in mild discordants. However, in its present form, the fetal ponderal index is a poor predictor of discordant growth and therefore should be employed cautiously in twin gestations.
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Ben-Arie A, Weissman A, Steinberg Y, Levy R, Hagay Z. Oligohydramnios, intrauterine growth retardation and fetal death due to umbilical cord torsion. Arch Gynecol Obstet 1995; 256:159-61. [PMID: 7574909 DOI: 10.1007/bf01314645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Intrauterine fetal death was observed in a woman at 35 gestational weeks shortly after she was admitted to hospital due to suspected placental insufficiency expressed by oligohydramnios and fetal growth retardation. The pathologic examination showed umbilical cord torsion and an organized thrombus at the site of the torsion. This findings could imply that both the fetal death and the placental insufficiency were the results of the cord torsion.
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Shoham Z, Schacter M, Loumaye E, Weissman A, MacNamee M, Insler V. The luteinizing hormone surge--the final stage in ovulation induction: modern aspects of ovulation triggering. Fertil Steril 1995; 64:237-51. [PMID: 7615097 DOI: 10.1016/s0015-0282(16)57717-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compile updated information regarding gonadotropin secretion, specifically the physiology of the midcycle LH surge, in natural cycles and under various ovulation induction protocols. DATA IDENTIFICATION AND SELECTION Studies that deal with the clinical aspects of LH surge manipulation or substitution were identified through literature and Medline searches. RESULTS Three major regulatory factors have been identified as participants in the induction of the midcycle gonadotropin surge. These are hypothalamic GnRH secretion, ovarian and adrenal steroids, and less well-characterized ovarian peptide hormones. Gonadotropin-releasing hormone pulsatility is regulated by a complex mechanism that integrates multiple neurotransmitters and sex steroids. Estradiol plays a central role in the pituitary secretion of LH, which also is influenced by P concentrations. Gonadotropin surge attenuating factor also has been implicated in the regulation of timing and amplitude of the LH surge. Human chorionic gonadotropin is used extensively as a LH surrogate, but its use is associated with a number of disadvantages. Induction of an endogenous LH surge through use of the flare effect of GnRH analogues has been examined more recently and has been found to have several advantages. Recombinant human LH is in the final stages of clinical testing. CONCLUSION Although much is known about the physiology of the midcycle LH surge and its variations under different clinical conditions, new approaches to the induction or substitution of the LH surge currently are being examined and learned. The introduction of recombinant gonadotropins into clinical practice is likely to influence ovulation induction and IVF practice to a significant degree in the near future.
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Weissman A, Grisaru D, Shenhav M, Peyser RM, Jaffa AJ. Postpartum surveillance of urinary retention by ultrasonography: the effect of epidural analgesia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 1995; 6:130-134. [PMID: 8535916 DOI: 10.1046/j.1469-0705.1995.06020130.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Our objective was to investigate by ultrasonography whether the risk for postpartum urinary retention is increased following administration of epidural analgesia during labor and delivery. In a prospective study, 106 healthy women who had undergone vaginal delivery were evaluated. Sixty-eight of the women had received epidural analgesia during labor and delivery. All subjects had an ultrasound examination at a mean of 42 h after delivery, and residual urine volume was estimated immediately after voiding. Correlations among obstetric parameters, epidural analgesia and residual urine volumes were evaluated. The mean accuracy rate of ultrasonography for estimation of bladder volumes was +/- 10.2%. No cases of clinically evident urinary retention were diagnosed in the total puerperal population. There were no significant differences between the groups in the average amounts of residual urine as measured by ultrasonography. With modern obstetric practice, epidural analgesia for labor is not associated with an increased risk for postpartum urinary retention. The non-invasive nature of ultrasound renders it especially attractive and useful for measuring residual urine volume in postpartum patients. The safety, simplicity and relative comfort of this method over-ride the slightly imperfect calculations that it currently yields, and makes it preferable to catheterization or cystometry for evaluation of residual urine volume.
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Elchalal U, Weissman A, Abramov Y, Abramov D, Weinstein D. Intrapartum fetal pulse oximetry: present and future. Int J Gynaecol Obstet 1995; 50:131-7. [PMID: 7589747 DOI: 10.1016/0020-7292(95)02440-n] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pulse oximetry is widely used to monitor the patient's well-being in anesthetic and neonatal practice. As a result of recent technologic and theoretical advances, it has emerged as a clinical tool in intrapartum fetal monitoring. Oximeters record both pulse rate and arterial oxygen saturation of the fetus and they may be adapted to derive an estimate of peripheral perfusion. Reflectance oximetry is more accurate than transmission oximetry in intrapartum fetal management. This method uses the pulsatile changes of red and infrared light reflected from tissue to estimate arterial oxygenation. Pulse oximetry is cheap, non-invasive, simple to operate, relatively accurate and has a fast response time. Factors adversely affecting the accuracy of the pulse oximeter output include transducer displacement, peripheral vasoconstriction, hypotension, anemia, presence of intravascular dyes, meconium staining, fetal hair and scalp edema. Fetal pulse oximetry is limited by a wide normal range and inadequate calibration. The amniochorionic membranes however do not affect oximetry readings so that this method may be applied before rupture of the membranes, i.e. before labor. Once successfully developed, fetal pulse oximetry could potentially be used in combination with other monitoring techniques to reduce instrumental and operative interventions during labor and improve perinatal outcome.
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Ben-Arie A, Weissman A, Steinberg Y, Levy R, Hagay Z. Case reports Oligohydramnios, intrauterine growth retardation and fetal death due to umbilical cord torsion. Arch Gynecol Obstet 1995. [DOI: 10.1007/s004040050085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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122
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Blickstein I, Zalel Y, Weissman A. Pregnancy order. A factor influencing birth weight in twin gestations. THE JOURNAL OF REPRODUCTIVE MEDICINE 1995; 40:443-6. [PMID: 7650657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To test the hypothesis that increased twin birth weight is expected with increased parity, we conducted a retrospective, cross-sectional evaluation of 430 twins, focusing on birth weight and growth discordance parameters in five parity groups (para 1-4 and > or = 5). The mean birth weight of twin A, B and both twins was significantly lower in primiparous patients as compared to para 2-4 but not as compared to para > or = 5 patients. The frequency of twins weighing < 1,500 g was similar in all groups, but a significantly higher frequency of twins weighing 1,500-2,500 g and lower frequency at > 2,500-g twins were found in the para 1 group as compared to the groups with higher parities. Presentation combinations were not different in the five parity groups, nor were the frequencies of growth discordance categories. However, discordants among pairs, with each infant weighing < 2,500 g, occurred almost twice as often in para > or = 5 as compared to the other parity groups. Our data indicate that primiparae seem to have significantly smaller twins as compared to multiparae. This trend was independent of the presentation combinations and growth discordance pattern and seems to result from a higher frequency of twins weighing 1,500-2,500 g in primiparae.
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Weissman A, Hagay ZJ. Management of breech presentation: the 1993 Israeli census. Eur J Obstet Gynecol Reprod Biol 1995; 60:21-8. [PMID: 7635225 DOI: 10.1016/0028-2243(95)02054-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To investigate current attitudes to management of labor and delivery in pregnancies complicated by breech presentation. STUDY DESIGN A questionnaire was sent to the directors of 23 units of maternal-fetal medicine, all members of the Israel Society of Perinatal Obstetricians. The survey included 69,072 deliveries in the year 1993. Current world literature on the topics included in the survey was also reviewed. RESULTS The overall response rate was 83% (19/23). The overall breech presentation rate was 3.4%, and overall caesarean section rate was 11.2%. In breech presentation, the caesarean section rate was 63.6%. CONCLUSIONS A rational approach allows vaginal breech delivery to be practiced in almost half of carefully selected cases. These results again emphasize the longstanding need for prospective randomized studies regarding the different aspects associated with the delivery of the fetus in breech presentation.
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Hagay ZJ, Weissman A, Geva D, Snir E, Caspi A. Labor and delivery complicated by acute mitral regurgitation due to ruptured chordae tendineae. Am J Perinatol 1995; 12:111-2. [PMID: 7779190 DOI: 10.1055/s-2007-994418] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Acute mitral regurgitation due to ruptured chordae tendineae is a dramatic and life-threatening clinical situation. Rarely does this complication occur during pregnancy. We present a case of a 30-year-old woman in week 31 of her pregnancy who developed acute mitral regurgitation, secondary to bacterial endocarditis and ruptured chordae tendineae. This acute event resulted in preterm labor a few hours later. Delivery was uneventful and successful and was followed by open heart surgery 5 days later. A review of the literature on chordae tendineae rupture and resulting mitral regurgitation during pregnancy is presented.
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Levy R, Weissman A, Hagay Z. [Parvovirus B19 infection in pregnancy]. HAREFUAH 1995; 128:234-7. [PMID: 7744336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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